Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements: A prospective, randomly assigned, blinded study

Helen L. Thomson, Arsene Joseph Basmadjian, Andrew J. Rainbird, Mehdi Razavi, Jean Francois Avierinos, Patricia Pellikka, Kent R Bailey, Jerome F. Breen, Maurice E Sarano

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)867-875
Number of pages9
JournalJournal of the American College of Cardiology
Volume38
Issue number3
DOIs
StatePublished - 2001

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Ventricular Remodeling
Echocardiography
Injections
X Ray Computed Tomography
Stroke Volume
Left Ventricular Dysfunction

ASJC Scopus subject areas

  • Nursing(all)

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Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements : A prospective, randomly assigned, blinded study. / Thomson, Helen L.; Basmadjian, Arsene Joseph; Rainbird, Andrew J.; Razavi, Mehdi; Avierinos, Jean Francois; Pellikka, Patricia; Bailey, Kent R; Breen, Jerome F.; Sarano, Maurice E.

In: Journal of the American College of Cardiology, Vol. 38, No. 3, 2001, p. 867-875.

Research output: Contribution to journalArticle

Thomson, Helen L. ; Basmadjian, Arsene Joseph ; Rainbird, Andrew J. ; Razavi, Mehdi ; Avierinos, Jean Francois ; Pellikka, Patricia ; Bailey, Kent R ; Breen, Jerome F. ; Sarano, Maurice E. / Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements : A prospective, randomly assigned, blinded study. In: Journal of the American College of Cardiology. 2001 ; Vol. 38, No. 3. pp. 867-875.
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abstract = "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.",
author = "Thomson, {Helen L.} and Basmadjian, {Arsene Joseph} and Rainbird, {Andrew J.} and Mehdi Razavi and Avierinos, {Jean Francois} and Patricia Pellikka and Bailey, {Kent R} and Breen, {Jerome F.} and Sarano, {Maurice E}",
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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

AU - Bailey, Kent R

AU - Breen, Jerome F.

AU - Sarano, Maurice E

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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