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. 2019 Jul-Sep;29(3):103-110.
doi: 10.4103/jcecho.jcecho_19_19.

The Utility of Eccentricity Index as a Measure of the Right Ventricular Function in a Lung Resection Cohort

Wai Huang Teng  1 , Philip J McCall  1   2 , Benjamin G Shelley  1   2
Affiliations

The Utility of Eccentricity Index as a Measure of the Right Ventricular Function in a Lung Resection Cohort

Wai Huang Teng et al. J Cardiovasc Echogr. 2019 Jul-Sep.

Abstract

Context: Right ventricular (RV) dysfunction occurs after lung resection and is associated with postoperative morbidity. Noninvasive evaluation of the RV is challenging, particularly in the postoperative period. A reliable measure of RV function would have value in this population.

Aims: This study compares eccentricity index (EI) obtained by transthoracic echocardiography (TTE) with cardiovascular magnetic resonance (CMR) determined measures of RV function in a lung resection cohort. CMR is the reference method for noninvasive assessment of RV function.

Design and setting: Prospective observational cohort study at a single tertiary hospital.

Materials and methods: Twenty-eight patients scheduled for elective lung resection underwent contemporaneous TTE and CMR imaging preoperatively, on postoperative day (POD) 2 and at 2-month. Systolic and diastolic EI was measured offline from anonymized and randomized TTE and CMR images.

Statistical analysis: Bland-Altman analysis was performed to determine agreement between EITTE and EICMR. Changes over time and comparison with CMR determined RV ejection fraction (RVEFCMR) was assessed.

Results: Bland-Altman analysis showed a negligible mean difference between EITTE and EICMR, but limits of agreement were wide (SD 0.24 and 0.28). There were no significant changes in EITTE and EICMR over time (P > 0.35). We found no association between EITTE with RVEFCMR at all-time points (P > 0.22). Systolic and diastolic EICMR on POD 2 demonstrated moderate association with RVEFCMR (r = -0.54 and r = -0.59, P ≤ 0.01). At 2-month, only diastolic EICMR correlated with RVEFCMR (r = -0.43, P = 0.03). There were no meaningful associations between EITTE and EICMR with TTE-derived RV systolic pressure (P > 0.31).

Conclusions: TTE determined EI is not useful as a noninvasive method of assessing RV function following lung resection.

Keywords: Cardiovascular magnetic resonance; eccentricity index; lung resection; right ventricle; transthoracic echocardiography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Echocardiographic parasternal short-axis view at the mid-left ventricle level during end-systole (a) and end-diastole (b), demonstrating an abnormal flattened septum. Eccentricity index is defined as the ratio of D2/D1, where D1 is the LV short-axis diameter perpendicular to the septum and D2 is the left ventricle short-axis diameter parallel to the septum. (a) EITTE = 1.44 and (b) EITTE = 1.44
Figure 2
Figure 2
Short-axis cardiovascular magnetic resonance image plane at the mid-left ventricle level during end-systole (a) and end-diastole (b), showing an abnormal flattened septum. D1 is defined as the LV short-axis diameter perpendicular to the septum and D2 is defined as the LV short-axis diameter parallel to the septum. Eccentricity index (D2/D1) is 1.33 in (a) and 1.65 in (b)
Figure 3
Figure 3
Bland–Altman analysis assessing the agreement between EI measured by TTE and CMR at systole (a) and diastole (b). Limits of agreement were defined as mean ± 1.96 standard deviation. EI = Eccentricity index, TTE = Transthoracic echocardiography, CMR = Cardiovascular magnetic resonance
Figure 4
Figure 4
The association of postoperative day 2 RV ejection fraction with, systolic EICMR (a) and diastolic EICMR (b) (r = −0.54 and r = −0.59 respectively, P < 0.01 for both, Pearson correlation). POD 2 = Postoperative day 2, RV = Right ventricle, EI = Eccentricity index, CMR=Cardiovascular magnetic resonance
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