Utility of three-dimensional echocardiography for evaluating right ventricular size and function and ventricular myocardial deformation in repaired tetralogy of fallot.

3DE showed strong correlation with CMR for RV end-diastolic volume measurements in repaired TOF patients.

• Correlation coefficient for RVEDV between 3DE and CMR was r = 0.95
• Correlation coefficient for RVEDVi between 3DE and CMR was r = 0.91
• 3DE demonstrated mild underestimation of RV volumes compared to CMR
• Study included 43 patients with rTOF who underwent same-day 2DE, 3DE, and CMR between November 2023 and December 2024

RVEF measured by 3DE was significantly lower than RVEF measured by CMR.

• 3DE RVEF was 46.4 ± 8.8% versus CMR RVEF of 50.3 ± 7.3%
• The difference was statistically significant (p = 0.002)
• This represents a modest underestimation of functional parameters by 3DE relative to CMR

RV global longitudinal strain values differed significantly between 3DE and 2DE modalities.

• 3DE yielded more negative RV-GLS values than 2DE (-20.3 ± 4.4% vs. -18.5 ± 4.7%)
• The difference was statistically significant (p = 0.009)
• More negative strain values from 3DE indicate a systematic difference in strain quantification between modalities

Both 2D and 3D echocardiography-derived RV-GLS were significantly reduced in patients with CMR-defined RV systolic dysfunction.

• Abnormal RV strain was observed in patients with CMR-RVEF < 48%
• Both 2DE and 3DE RV-GLS were significantly reduced in this subgroup
• AUC curves were used to evaluate diagnostic accuracy for detecting RV systolic dysfunction
• This finding supports the clinical relevance of strain analysis for identifying RV dysfunction

CMR remains the gold standard for RV assessment but is limited by accessibility and cost, motivating evaluation of 3DE as an alternative.

• RV dysfunction is described as a major long-term complication in patients with repaired Tetralogy of Fallot
• 3DE with strain imaging capabilities is described as a promising alternative for serial evaluation of RV size and function
• The study retrospectively analyzed 43 patients who underwent same-day 2DE, 3DE, and CMR
• Correlation, Bland-Altman analysis, and AUC curves were used to evaluate agreement and diagnostic accuracy