Accuracy of 3-dimensional echocardiography in measuring right ventricular volumes and ejection fraction: a systematic review and meta-analysis

The complex architecture of the right ventricle presents a significant challenge in determining its functional status. Three-dimensional echocardiography (3DE) is growing in prevalence as a faster and more convenient tool to evaluate Right Ventricular (RV) function. However, its accuracy and concordance with cardiac magnetic resonance imaging (CMR) is yet to be determined. In this study, we conducted a comprehensive systematic review and meta-analysis to evaluate the agreement of 3DE to CMR for RV functional assessment. We conducted a systematic literature review of PubMed, Embase, and the Cochrane Library through to December 2024. Studies were included if they directly compared 3DE and CMR measurements of RV function and volumes. Data synthesis was carried out with RevMan Web using a random-effects model. Seventy-five studies were included in the analysis. 3DE systematically underestimated RV volumes compared to CMR, with significant differences for end-diastolic volume (SMD = −0.43, 95% CI: −0.55, −0.30) and end-systolic volume (SMD: −0.27, 95% CI: −0.39, −0.16). However, for RV ejection fraction, 3DE showed minimal underestimation (MD: −0.92%, 95% CI: −2.20, 0.36) with no statistically significant difference (p: 0.16). These findings support the potential clinical utility of 3DE for RV ejection fraction assessment while highlighting the continued importance of CMR for precise volume measurements.