CLINICAL STUDY: NEW METHODS
Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements
A prospective, randomly assigned, blinded study
Helen L. Thomson, MD, PhD*,
Arsene-Joseph Basmadjian, MD*,
Andrew J. Rainbird, MD*,
Mehdi Razavi, MD*,
Jean-Francois Avierinos, MD*,
Patricia A. Pellikka, MD, FACC*,
Kent R. Bailey, PhD ,
Jerome F. Breen, MD* and
Maurice Enriquez-Sarano, MD, FACC*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Manuscript received December 20, 2000;
revised manuscript received April 16, 2001,
accepted May 15, 2001.
Reprint requests and correspondence: Dr. Maurice Enriquez-Sarano, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
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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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | EBCT | = electron beam computed tomography | | EDV | = end-diastolic volume | | EF | = ejection fraction | | ESV | = end-systolic volume | | LV | = left ventricular | | SV | = stroke volume |
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