Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2- and 3-Dimensional Transthoracic Echocardiography Comparison With Magnetic Resonance Imaging as the Reference Standard
Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2- and 3-Dimensional Transthoracic Echocardiography Comparison With Magnetic Resonance Imaging as the Reference Standard
复制标题
DOI：
10.1016/j.jacc.2012.01.046
复制
发表时间：
2012-05-22
影响因子：
24
通讯作者：
Dewey, Marc
中科院分区：
文献类型：
--
作者：
Greupner, Johannes;Zimmermann, Elke;Dewey, Marc
目的 本研究旨在比较64排对比计算机断层扫描（CT）、有创心室造影（CVG）、二维超声心动图（2D Echo）和三维超声心动图（3D Echo）与磁共振成像（MRI）在评估左心室（LV）功能方面的准确性。
背景 心功能是治疗的重要决定因素，也是冠心病患者长期生存的主要预测指标。有多种方法可用于评估心功能，但在同一患者中对这些多种方法进行比较的数据有限。
方法 共有36例患者前瞻性地接受了64排CT、CVG、2D Echo、3D Echo和MRI（作为参考标准）检查。测量了整体和局部左心室壁运动以及射血分数（EF）。此外，还进行了观察者间一致性的评估。
结果 对于整体EF，Bland - Altman分析显示CT与MRI之间的一致性显著更高（p < 0.005，95%置信区间：±14.2%），优于CVG（±20.2%）和3D Echo（±21.2%）。与MRI（55.6 ± 16.0%）相比，只有CVG（59.5 ± 13.9%，p = 0.03）显著高估了EF。CT在每搏输出量方面显示出比2D Echo、3D Echo和CVG更好的一致性。与MRI相比，CVG（而非CT）显著高估了舒张末期容积（p < 0.001），而2D Echo和3D Echo则显著低估了舒张末期容积（p < 0.05）。在与MRI比较时，4种方法在评估局部左心室功能的诊断准确性（范围：76% - 88%）方面没有显著差异。EF的观察者间一致性在64排CT、MRI、2D Echo和3D Echo中显示出较高的组内相关性（组内相关系数>0.8），而CVG的一致性较低（组内相关系数 = 0.58）。
结论 与作为评估整体左心室功能参考标准的MRI相比，64排CT可能比CVG、2D Echo和3D Echo更准确。（《美国心脏病学会杂志》2012年；59：1897 - 1907）（C）2012年美国心脏病学会基金会
Objectives This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI).Background Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients.Methods A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed.Results For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: +/- 14.2%) than for CVG (+/- 20.2%) and 3D Echo (+/- 21.2%). Only CVG (59.5 +/- 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 +/- 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58).Conclusions 64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function. (J Am Coll Cardiol 2012;59:1897-907) (C) 2012 by the American College of Cardiology Foundation