CLINICAL RESEARCH: CARDIAC IMAGING
Analysis of Regional Left Ventricular Function by Cineventriculography, Cardiac Magnetic Resonance Imaging, and Unenhanced and Contrast-Enhanced Echocardiography
A Multicenter Comparison of Methods
Rainer Hoffmann, MD*,*,
Stephan von Bardeleben, MD ,
Jaroslaw D. Kasprzak, MD ,
Adrian C. Borges, MD ,
Folkert ten Cate, MD||,
Christian Firschke, MD, FACC¶,
Stephane Lafitte, MD#,
Nidal Al-Saadi, MD**,
Stefanie Kuntz-Hehner, MD,
Georg Horstick, MD,
Christian Greis,
Marc Engelhardt, MD,
Jean Louis Vanoverschelde, MD, FACC|||| and
Harald Becher, MD¶¶
* University Rheinisch-Westfälischen Technischen Hochschule Aachen, Aachen, Germany
Clinic Johannes Gutenberg University Mainz, Mainz, Germany
Medical University, Lodz, Poland
University Charite, Berlin, Germany
|| Academic Hospital Dijkzigt Rotterdam, the Netherlands
¶ Deutsches Herzzentrum, Munich, Germany
# Hopital du Haut Leveque, Pessac Cedex, France
** University Charite, Berlin, Germany
University Bonn, Bonn, Germany
Bracco-Altana-Pharma, Konstanz, Germany
Bracco Diagnostics, Princeton, New Jersey
|||| Cliniques Universitaires Saint-Luc, Brussels, Belgium
¶¶ John Radcliffe Hospital, Oxford, United Kingdom.
Manuscript received February 1, 2005;
revised manuscript received May 21, 2005,
accepted May 31, 2005.
* Reprint requests and correspondence: Dr. Rainer Hoffmann, Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany. (Email: rhoffmann{at}ukaachen.de).
OBJECTIVES: To define the use of cineventriculography, cardiac magnetic resonance imaging (cMRI), and unenhanced and contrast-enhanced echocardiography for detection of left ventricular (LV) regional wall motion abnormalities (RWMA).
BACKGROUND: Detection of RWMA is integral to the evaluation of LV function.
METHODS: In 100 patients, cineventriculography and unenhanced and contrast-enhanced echocardiography were performed. Fifty-six of the patients underwent additional cMRI. RWMA were assessed referring to a 16-segment model for cMRI, unenhanced and contrast echocardiography. Cineventriculography was evaluated on a 7-segment model. Hypokinesia in one or more segments defined presence of RWMA. Interobserver agreement among three readers was determined within each imaging modality. Intermethod agreement between imaging modalities was analyzed. A standard of truth for the presence of RWMA was obtained by an independent expert panel decision (EPD) based on clinical data, electrocardiogram, coronary angiography, and blinded information from the imaging modalities.
RESULTS: Sixty-seven patients were found to have an RWMA by EPD. Interobserver agreement expressed as kappa coefficient was 0.41 (range 0.37 to 0.44) for unenhanced echocardiography, 0.43 (range 0.29 to 0.79) for cMRT, 0.56 (range 0.44 to 0.70) for cineventriculography, and 0.77 (range 0.71 to 0.88) for contrast echocardiography. Contrast enhancement compared to unenhanced echocardiography improved agreement of echocardiography related to cMRI (kappa 0.46 vs. 0.29) and related to cineventriculography (kappa 0.59 vs. 0.28). Accuracy to detect EPD-defined RWMA was highest for contrast echocardiography, followed by cMRI, unenhanced echocardiography, and cineventriculography.
CONCLUSIONS: Analysis of RWMA is characterized by considerable interobserver variability even using high-quality imaging modalities. Interobserver agreement on RWMA and accuracy to detect panel-defined RWMA is good using contrast echocardiography.
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Abbreviations and Acronyms
| | cMRI = cardiac magnetic resonance imaging | | ECG = electrocardiogram | | EPD = expert panel decision | | IOA = interobserver agreement | | LV = left ventricle/ventricular | | RWMA = regional wall motion abnormality | | OffR = off-site reader | | OnR = on-site reader |
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