Manual correction of semi-automatic three-dimensional echocardiography is needed for right ventricular assessment in adults; validation with cardiac magnetic resonance

62 non-selected patients were examined with 3DE (Sonos 7500 and iE33) and with CMR (1.5T). Endocardial RV contours of 3DE-images were semi-automatically assessed and manually corrected in all patients. End-diastolic (EDV), end-systolic (ESV) volumes, stroke volume (SV) and ejection fraction (EF) were computed.53 patients (85%) had 3DE-images feasible for examination. Correlation coefficients and Bland Altman biases between 3DE with manual correction and CMR were r = 0.78, -22 ± 27 mL for EDV, r = 0.83, -7 ± 16 mL for ESV, r = 0.60, -12 ± 18 mL for SV and r = 0.60, -2 ± 8% for EF (p < 0.001 for all r-values). Without manual correction r-values were 0.77, 0.77, 0.70 and 0.49 for EDV, ESV, SV and EF, respectively (p < 0.001 for all r-values) and biases were larger for EDV, SV and EF (-32 ± 26 mL, -21 ± 15 mL and - 6 ± 9%, p ≤ 0.01 for all) compared to manual correction.Manual correction of the 3DE semi-automatic RV delineation decreases the bias and is needed for acceptable clinical accuracy. 3DE is highly feasible for visualizing the RV in an adult clinical setting.Assessment of the right ventricular volumes and function is of great importance in the diagnosis of various heart diseases e.g. pulmonary hypertension and congenital heart disease [1-3], for the choice of therapeutical strategies [4] and not least of prognostic value [5-7].Two-dimensional echocardiography (2DE) is the most commonly used clinical imaging modality in the evaluation of the right ventricle (RV). The complex geometrical structure of the RV with both a crescent shape and an outspread inflow and outflow tract requires a combination of several different scan planes for estimation of size and function with 2DE. M-Mode and tissue Doppler imaging of the free lateral wall of the RV are measurements in one point and are used as surrogates for the RV function. Hence, current echocardiographic techniques are not suitable for calculating right ventricular volumes and function accurately with a simple algor