TY - JOUR
T1 - Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements
T2 - A prospective, randomly assigned, blinded study
AU - Thomson, Helen L.
AU - Basmadjian, Arsene Joseph
AU - Rainbird, Andrew J.
AU - Razavi, Mehdi
AU - Avierinos, Jean Francois
AU - Pellikka, Patricia A.
AU - Bailey, Kent R.
AU - Breen, Jerome F.
AU - Enriquez-Sarano, Maurice
N1 - Funding Information:
Dr. Thomson was supported by a Research Fellowship Grant from the Royal Australian College of Physicians. Dr. Basmadjian was supported by a grant of the American Society of Echocardiography. The study was supported by a grant from the Mayo Foundation, Rochester, Minnesota. This study was also supported in part by the grants HL64928 and RR00585 of the National Institutes of Health.
PY - 2001
Y1 - 2001
N2 - OBJECTIVES: We sought to assess the impact of contrast injection and harmonic imaging, on the measure by echocardiography of left ventricular (LV) remodeling. BACKGROUND: Left ventricular remodeling is a precursor of LV dysfunction, but the impact of contrast injection and harmonic imaging on the accuracy or reproducibility of echocardiography is unclear. METHODS: We prospectively collected LV images by using simultaneous methods. Then, LV volumes were measured off-line, in blinded manner and in random order. The accuracy of echocardiography was determined in comparison to electron beam computed tomography (EBCT) in 26 patients. The reproducibility of echocardiography was assessed by three blinded observers with different training levels in 32 patients. RESULTS: End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), as measured by EBCT (195 ± 55, 58 ± 24 and 137 ± 35 ml and 71 ± 5%, respectively) and echocardiography with harmonic imaging and contrast injection (194 ± 51, 55 ± 20 and 140 ± 35 ml and 72 ± 4%, respectively), showed no differences (all p > 0.15) and excellent correlations (all r > 0.87). In contrast, echocardiography using harmonic imaging without contrast injection underestimated the EBCT results (all p < 0.01). Reproducibility was superior with rather than without contrast injection for intraobserver and interobserver variabilities (all p < 0.001). Values measured by different observers were different without contrast injection, but were similar with contrast injection (all p > 0.18). Consequently, intrinsic patient differences represented a larger and almost exclusive proportion of global variability with contrast injection for EDV (94 vs. 79%), ESV (93 vs. 82%), SV (87 vs. 53%) and EF (84 vs. 41%), as compared with harmonic imaging without contrast injection (all p < 0.005). CONCLUSIONS: For assessment of LV remodeling, echocardiography with harmonic imaging and contrast injection improved the accuracy and reproducibility, as compared with imaging without contrast injection. With contrast injection, variability was almost exclusively due to intrinsic patient differences. Therefore, when evaluation of LV remodeling is deemed important, assessment after contrast injection should be the preferred echocardiographic approach.
AB - OBJECTIVES: We sought to assess the impact of contrast injection and harmonic imaging, on the measure by echocardiography of left ventricular (LV) remodeling. BACKGROUND: Left ventricular remodeling is a precursor of LV dysfunction, but the impact of contrast injection and harmonic imaging on the accuracy or reproducibility of echocardiography is unclear. METHODS: We prospectively collected LV images by using simultaneous methods. Then, LV volumes were measured off-line, in blinded manner and in random order. The accuracy of echocardiography was determined in comparison to electron beam computed tomography (EBCT) in 26 patients. The reproducibility of echocardiography was assessed by three blinded observers with different training levels in 32 patients. RESULTS: End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), as measured by EBCT (195 ± 55, 58 ± 24 and 137 ± 35 ml and 71 ± 5%, respectively) and echocardiography with harmonic imaging and contrast injection (194 ± 51, 55 ± 20 and 140 ± 35 ml and 72 ± 4%, respectively), showed no differences (all p > 0.15) and excellent correlations (all r > 0.87). In contrast, echocardiography using harmonic imaging without contrast injection underestimated the EBCT results (all p < 0.01). Reproducibility was superior with rather than without contrast injection for intraobserver and interobserver variabilities (all p < 0.001). Values measured by different observers were different without contrast injection, but were similar with contrast injection (all p > 0.18). Consequently, intrinsic patient differences represented a larger and almost exclusive proportion of global variability with contrast injection for EDV (94 vs. 79%), ESV (93 vs. 82%), SV (87 vs. 53%) and EF (84 vs. 41%), as compared with harmonic imaging without contrast injection (all p < 0.005). CONCLUSIONS: For assessment of LV remodeling, echocardiography with harmonic imaging and contrast injection improved the accuracy and reproducibility, as compared with imaging without contrast injection. With contrast injection, variability was almost exclusively due to intrinsic patient differences. Therefore, when evaluation of LV remodeling is deemed important, assessment after contrast injection should be the preferred echocardiographic approach.
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U2 - 10.1016/S0735-1097(01)01416-4
DO - 10.1016/S0735-1097(01)01416-4
M3 - Article
C2 - 11527647
AN - SCOPUS:0034847913
SN - 0735-1097
VL - 38
SP - 867
EP - 875
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -