The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
P Rizzon - One of the best experts on this subject based on the ideXlab platform.
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detection of coronary artery disease by digital stress Echocardiography comparison of exercise transesophageal atrial pacing and dipyridamole Echocardiography
Journal of the American College of Cardiology, 1994Co-Authors: Vito Marangelli, Sabino Iliceto, Giovanni Piccinni, Giulia De Martino, L Sorgente, P RizzonAbstract:Objectives. This study assessed and compared the diagnostic potential of exercise, transesophageal atrial pacing and dipyridamole stress Echocardiography in a clinical setting. Background. Although they have been widely studied, no data exist with regard to comparisons of these procedures in a head-to-head study in different clinical settings. Methods. One hundred four consecutive patients with suspected coronary artery disease undergoing coronary angiography and with no previous myocardial infarction or rest left ventricular wall motion abnormalities underwent digital posttreadmill, transesophageal atrial pacing and dipyridamole Echocardiography. Results. Feasibility of digital exercise Echocardiography was 84%; 8 of 88 remaining patients had a nondiagnostic exercise Echocardiographic test (inadequate exercise or imaging). In 80 patients with feasible and diagnostic digital exercise Echocardiography, sensitivity, specificity and accuracy were, respectively, 89%, 91% and 90%. Eighty of the 104 patients underwent transesophageal atrial pacing and dipyridamole Echocardiography. Feasibility of the alternative stress procedures was 77% for transesophageal atrial pacing and 96% for dipyridamole. In 60 patients successfully undergoing both alternative stress procedures, sensitivity and specificity were 83% and 76% for atrial pacing and 43% and 92% for dipyridamole Echocardiography, respectively. In the group of 24 patients with nondiagnostic exercise Echocardiography and consequent indication to alternative stress procedures, accuracy of transesophageal atrial pacing was higher than that of dipyridamole Echocardiography (73% vs. 45%, p = 0.06). Conclusions. Because of its higher diagnostic potential and additional functional information, exercise is the stress of choice when stress Echocardiography is used to detect the presence of coronary artery disease. Alternative stresses can be used in patients with nondiagnostic exercise Echocardiography. Transesophageal and dipyridamole Echocardiography differ in feasibility and diagnostic reliability (higher sensitivity of transesophageal atrial pacing, higher specificity of dipyridamole). These characteristics must be considered when selecting procedures to be used as alternatives to exercise.
Vito Marangelli - One of the best experts on this subject based on the ideXlab platform.
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detection of coronary artery disease by digital stress Echocardiography comparison of exercise transesophageal atrial pacing and dipyridamole Echocardiography
Journal of the American College of Cardiology, 1994Co-Authors: Vito Marangelli, Sabino Iliceto, Giovanni Piccinni, Giulia De Martino, L Sorgente, P RizzonAbstract:Objectives. This study assessed and compared the diagnostic potential of exercise, transesophageal atrial pacing and dipyridamole stress Echocardiography in a clinical setting. Background. Although they have been widely studied, no data exist with regard to comparisons of these procedures in a head-to-head study in different clinical settings. Methods. One hundred four consecutive patients with suspected coronary artery disease undergoing coronary angiography and with no previous myocardial infarction or rest left ventricular wall motion abnormalities underwent digital posttreadmill, transesophageal atrial pacing and dipyridamole Echocardiography. Results. Feasibility of digital exercise Echocardiography was 84%; 8 of 88 remaining patients had a nondiagnostic exercise Echocardiographic test (inadequate exercise or imaging). In 80 patients with feasible and diagnostic digital exercise Echocardiography, sensitivity, specificity and accuracy were, respectively, 89%, 91% and 90%. Eighty of the 104 patients underwent transesophageal atrial pacing and dipyridamole Echocardiography. Feasibility of the alternative stress procedures was 77% for transesophageal atrial pacing and 96% for dipyridamole. In 60 patients successfully undergoing both alternative stress procedures, sensitivity and specificity were 83% and 76% for atrial pacing and 43% and 92% for dipyridamole Echocardiography, respectively. In the group of 24 patients with nondiagnostic exercise Echocardiography and consequent indication to alternative stress procedures, accuracy of transesophageal atrial pacing was higher than that of dipyridamole Echocardiography (73% vs. 45%, p = 0.06). Conclusions. Because of its higher diagnostic potential and additional functional information, exercise is the stress of choice when stress Echocardiography is used to detect the presence of coronary artery disease. Alternative stresses can be used in patients with nondiagnostic exercise Echocardiography. Transesophageal and dipyridamole Echocardiography differ in feasibility and diagnostic reliability (higher sensitivity of transesophageal atrial pacing, higher specificity of dipyridamole). These characteristics must be considered when selecting procedures to be used as alternatives to exercise.
Ziyad M Hijazi - One of the best experts on this subject based on the ideXlab platform.
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intracardiac Echocardiography in structural heart disease interventions
Jacc-cardiovascular Interventions, 2018Co-Authors: Mohamad Alkhouli, Ziyad M Hijazi, Charanjit S Rihal, David R Holmes, Susan E WiegersAbstract:Abstract Intracardiac Echocardiography has historically been used to guide a limited number of transcatheter cardiac interventions. However, the tremendous advances in structural heart disease interventions in the last decade led to a growing interest in intracardiac Echocardiography as a potential alternative to transesophageal Echocardiography that mitigates the need for endotracheal intubation. Nonetheless, the scarcity of data, the imperfection of the current probes, and the limited experience among operators prevented a wider adoption of this technology. This review summarizes the contemporary relevant evidence and provides the structural interventionalist with an illustrative guide on the use of intracardiac Echocardiography to guide various structural heart interventions.
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transcatheter closure of multiple atrial septal defects initial results and value of two and three dimensional transoesophageal Echocardiography
European Heart Journal, 2000Co-Authors: Qiling Cao, W Radtke, Felix Berger, W Zhu, Ziyad M HijaziAbstract:Aims To examine the feasibility of transcatheter closure of multiple atrial septal defects using two Amplatzer devices simultaneously and to describe the importance and the role of two- and three-dimensional transoesophageal Echocardiography in the selection and closure of such defects. Methods Twenty-two patients with more than one atrial septal defect underwent an attempt at transcatheter closure of their atrial septal defects at a mean±SD age of 30·8±18·6 years (range 3·7–65·9 years) and mean weight of 56·6±25·5kg (range 12·9–99kg) using two Amplatzer devices implanted simultaneously via two separate delivery systems. During catheterization, two dimensional transoesophageal Echocardiography was performed in all but one patient, during and after transcatheter closure, while three dimensional transoesophageal Echocardiography was performed in six patients before and after transcatheter closure. Results Forty-four devices were deployed in all patients to close 45 defects (one patient with three defects closed by two devices). Two dimensional transoesophageal Echocardiography was helpful in selection and in guiding correct deployment of the devices. The mean size of the larger defect, as measured by transoesophageal Echocardiography was 12·8±5·9mm and the mean size of the smaller defect was 6·6±3·0mm. The mean size of the larger devices was 15±7·5mm, and 8·4±3·7mm for the smaller. Three dimensional transoesophageal Echocardiography provided superior imaging and demonstrated the number, shape and the surrounding structures of the atrial septal defects in one single view. The median fluoroscopy time was 28·7 min. Device embolization with successful catheter retrieval occurred in one patient. Forty-four devices were evaluated by colour Doppler transoesophageal Echocardiography immediately after the catheterization with a successful closure rate of 97·7%. On follow-up colour Doppler transthoracic Echocardiography demonstrated successful closure in 97·5% at 3 months. Conclusions The use of more than one Amplatzer septal occluder to close multiple atrial septal defects is safe and effective. The use of two- and three-dimensional transoesophageal Echocardiography provided useful information for transcatheter closure of multiple atrial septal defects using two devices. Three-dimensional transoesophageal Echocardiography enhanced our ability to image and understand the spatial relationship of the atrial septal defect anatomy.
Rainer Hoffmann - One of the best experts on this subject based on the ideXlab platform.
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analysis of left ventricular volumes and function a multicenter comparison of cardiac magnetic resonance imaging cine ventriculography and unenhanced and contrast enhanced two dimensional and three dimensional Echocardiography
Journal of The American Society of Echocardiography, 2014Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Giuseppe Barletta, Jeanlouis Vanoverschelde, Christian Greis, Stephan Von Bardeleben, Harald BecherAbstract:Background: Contrast Echocardiography improves accuracy and reduces interreader variability on left ventricular (LV)functional analyses inthe settingof two-dimensional (2D) Echocardiography. Theneedfor contrast imaging using three-dimensional (3D) Echocardiography is less defined. The aim of this multicenter study was to define the accuracy and interreader agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography for the assessment of LV volumes and ejection fraction (EF). Methods: A multicenter, open-label study was conducted including 63 patients, using intrasubject comparisons to assess the agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography as well as calibrated biplane cine ventriculography with cardiac magnetic resonance for the determination of LV volumes and EF. Each of the imaging techniques used to define LV function was assessed by two independent, off-site readers unaware of the results of the other imaging techniques. Results: LV end-systolic and end-diastolic volumes were underestimated by 2D and 3D unenhanced Echocardiography compared with cardiac magnetic resonance. Contrast enhancement resulted in similar significant increases in LV volumes on 2D and 3D Echocardiography. The mean percentage of interreader variability for LV EF was reduced from 14.3% (95% confidence interval [CI], 11.7%‐16.8%) for unenhanced 2D Echocardiography and 14.3% (95% CI, 9.7%‐18.9%) for unenhanced 3D Echocardiography to 8.0% (95% CI, 6.3%‐ 9.7%; P < .001) for contrast-enhanced 2D Echocardiography and 7.4% (95% CI, 5.7%‐9.1%; P < .01) for contrast-enhanced 3D Echocardiography and thus to a similar level as for cardiac magnetic resonance (7.9%; 95% CI, 5.4%‐10.5%). A similar effect was observed for interreader variability for LV volumes. Conclusions: Contrast administration on 3D Echocardiography results in improved determination of LV volumes and reduced interreader variability. The use of 3D Echocardiography requires contrast application as much as 2D Echocardiography to reduce interreader variability for volumes and EF. (J Am Soc Echocardiogr 2014;27:292-301.)
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analysis of left ventricular volumes and function a multicenter comparison of cardiac magnetic resonance imaging cine ventriculography and unenhanced and contrast enhanced two dimensional and three dimensional Echocardiography
Journal of The American Society of Echocardiography, 2014Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Stefan Von Bardeleben, Giuseppe Barletta, Jeanlouis Vanoverschelde, Christian Greis, Harald BecherAbstract:BACKGROUND: Contrast Echocardiography improves accuracy and reduces interreader variability on left ventricular (LV) functional analyses in the setting of two-dimensional (2D) Echocardiography. The need for contrast imaging using three-dimensional (3D) Echocardiography is less defined. The aim of this multicenter study was to define the accuracy and interreader agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography for the assessment of LV volumes and ejection fraction (EF). METHODS: A multicenter, open-label study was conducted including 63 patients, using intrasubject comparisons to assess the agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography as well as calibrated biplane cine ventriculography with cardiac magnetic resonance for the determination of LV volumes and EF. Each of the imaging techniques used to define LV function was assessed by two independent, off-site readers unaware of the results of the other imaging techniques. RESULTS: LV end-systolic and end-diastolic volumes were underestimated by 2D and 3D unenhanced Echocardiography compared with cardiac magnetic resonance. Contrast enhancement resulted in similar significant increases in LV volumes on 2D and 3D Echocardiography. The mean percentage of interreader variability for LV EF was reduced from 14.3% (95% confidence interval [CI], 11.7%-16.8%) for unenhanced 2D Echocardiography and 14.3% (95% CI, 9.7%-18.9%) for unenhanced 3D Echocardiography to 8.0% (95% CI, 6.3%-9.7%; P < .001) for contrast-enhanced 2D Echocardiography and 7.4% (95% CI, 5.7%-9.1%; P < .01) for contrast-enhanced 3D Echocardiography and thus to a similar level as for cardiac magnetic resonance (7.9%; 95% CI, 5.4%-10.5%). A similar effect was observed for interreader variability for LV volumes. CONCLUSIONS: Contrast administration on 3D Echocardiography results in improved determination of LV volumes and reduced interreader variability. The use of 3D Echocardiography requires contrast application as much as 2D Echocardiography to reduce interreader variability for volumes and EF.
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analysis of regional left ventricular function by cineventriculography cardiac magnetic resonance imaging and unenhanced and contrast enhanced Echocardiography a multicenter comparison of methods
Journal of the American College of Cardiology, 2006Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Stefan Von Bardeleben, Folkert Ten J Cate, Adrian C Borges, Christian Firschke, Stephane Lafitte, Nidal Alsaadi, Stephanie Kuntzhehner, Georg HorstickAbstract: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. lnterobserver agreement on RWMA and accuracy to detect panel-defined RWMA is good using contrast Echocardiography.
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assessment of systolic left ventricular function a multi centre comparison of cineventriculography cardiac magnetic resonance imaging unenhanced and contrast enhanced Echocardiography
European Heart Journal, 2005Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Stefan Von Bardeleben, Folkert Ten J Cate, Adrian C Borges, Christian Firschke, Stephane Lafitte, Nidal Alsaadi, Stephanie Kuntzhehner, Marc EngelhardtAbstract:Aims To assess the agreement of left ventricular ejection fraction (LVEF) determinations from unenhanced Echocardiography, contrast-enhanced Echocardiography, magnetic resonance imaging (MRI), and cineventriculography as well as the inter-observer agreement for each method. Methods and results In 120 patients, with evenly distributed EF-groups (G 55, 35-55, L 35%), cineventriculography, unenhanced Echocardiography with second harmonic imaging, and contrast Echocardiography at tow mechanical index with iv administration of SonoVueR were performed. In addition, cardiac MRI at 1.5T using a steady-state free precession sequence was performed in a subset of 55 patients. On-site, and two blinded off-site assessments were performed for unenhanced and contrast Echocardiography, cineventricutography, and MRI according to pre-defined standards. Intra-class correlation coefficients (ICCs) were determined to assess inter-observer reliability between all three readers (i.e. one on-site and two off-site). EF was 56.2 P 18.3% by cineventriculography, 54.1 P 12.9% by MRI, 50.9 P 15.3% by unenhanced Echocardiography, and 54.6 P 16.8% by contrast Echocardiography. Correlation on EF between cineventricutography and Echocardiography increased from 0.72 with unenhanced Echocardiography to 0.83 with contrast Echocardiography (P L 0.05). Similarly, correlation on EF between MRI and Echocardiography increased from 0.60 with unenhanced Echocardiography to 0.77 with contrast Echocardiography (P L 0.05). The inter-observer reliability ICC was 0.91 (95% CI 0.88-0.94) in contrast Echocardiography, followed by cardiac MRI (0.86; 95% CI 0.80-0.92), cineventricutography (0.80; 95% CI 0.74-0.85), and unenhanced Echocardiography (0.79; 95% CI 0.74-0.85). Conclusions Unenhanced Echocardiography resulted in slight underestimation of EF and only moderate correlation compared with cineventriculography and MRI. Contrast Echocardiography resulted in more accurate EF and significantly improved correlation with cineventriculography and MRI. Contrast Echocardiography significantly improved inter-observer agreement on EF compared with unenhanced Echocardiography. Interobserver reliability on EF using contrast Echocardiography reaches a level comparable to MRI and is better than those obtained by cineventriculography.
Jaroslaw D Kasprzak - One of the best experts on this subject based on the ideXlab platform.
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personal mobile device based pocket Echocardiograph the diagnostic value and clinical utility
Advances in Medical Sciences, 2019Co-Authors: Paulina Wejnermik, Dominika Filipiakstrzecka, Jaroslaw D Kasprzak, Dawid Miśkowiec, Adrianna Lorens, Piotr LipiecAbstract:Abstract Purpose A microUSB ultrasound probe, which can be connected to a personal mobile device constitutes a new class of diagnostic pocket-size imaging devices (PSID). The aim of this study was to assess the feasibility and diagnostic value of brief transthoracic Echocardiographic examination (bTTE) performed with the use of such equipment. Material and methods The study population comprised 87 consecutive patients (58 men, mean age 61 ± 16 years), 53 of whom were admitted to intensive cardiac care unit and 34 patients, who were referred for transthoracic Echocardiography from outpatient clinic. All patients underwent bTTE performed by cardiologist with the use of personal mobile device-based PSID. Within 18 h of bTTE all subjects underwent a standard TTE (sTTE) using a full sized Echocardiograph by expert Echocardiographer. Results In all patients, PSID imaging provided sufficient diagnostic image quality. Echocardiographic measurements were completed for both bTTE and sTTE in 98% of patients. The linear measurements obtained during bTTE showed good to excellent correlation with sTTE results (r = 0.65–0.98; p Conclusion Personal mobile device-based PSID allows for performing bTTE. The diagnostic value of such PSID in basic assessment of cardiac morphology and function as compared to standard Echocardiography is very good.
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analysis of left ventricular volumes and function a multicenter comparison of cardiac magnetic resonance imaging cine ventriculography and unenhanced and contrast enhanced two dimensional and three dimensional Echocardiography
Journal of The American Society of Echocardiography, 2014Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Stefan Von Bardeleben, Giuseppe Barletta, Jeanlouis Vanoverschelde, Christian Greis, Harald BecherAbstract:BACKGROUND: Contrast Echocardiography improves accuracy and reduces interreader variability on left ventricular (LV) functional analyses in the setting of two-dimensional (2D) Echocardiography. The need for contrast imaging using three-dimensional (3D) Echocardiography is less defined. The aim of this multicenter study was to define the accuracy and interreader agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography for the assessment of LV volumes and ejection fraction (EF). METHODS: A multicenter, open-label study was conducted including 63 patients, using intrasubject comparisons to assess the agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography as well as calibrated biplane cine ventriculography with cardiac magnetic resonance for the determination of LV volumes and EF. Each of the imaging techniques used to define LV function was assessed by two independent, off-site readers unaware of the results of the other imaging techniques. RESULTS: LV end-systolic and end-diastolic volumes were underestimated by 2D and 3D unenhanced Echocardiography compared with cardiac magnetic resonance. Contrast enhancement resulted in similar significant increases in LV volumes on 2D and 3D Echocardiography. The mean percentage of interreader variability for LV EF was reduced from 14.3% (95% confidence interval [CI], 11.7%-16.8%) for unenhanced 2D Echocardiography and 14.3% (95% CI, 9.7%-18.9%) for unenhanced 3D Echocardiography to 8.0% (95% CI, 6.3%-9.7%; P < .001) for contrast-enhanced 2D Echocardiography and 7.4% (95% CI, 5.7%-9.1%; P < .01) for contrast-enhanced 3D Echocardiography and thus to a similar level as for cardiac magnetic resonance (7.9%; 95% CI, 5.4%-10.5%). A similar effect was observed for interreader variability for LV volumes. CONCLUSIONS: Contrast administration on 3D Echocardiography results in improved determination of LV volumes and reduced interreader variability. The use of 3D Echocardiography requires contrast application as much as 2D Echocardiography to reduce interreader variability for volumes and EF.
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analysis of left ventricular volumes and function a multicenter comparison of cardiac magnetic resonance imaging cine ventriculography and unenhanced and contrast enhanced two dimensional and three dimensional Echocardiography
Journal of The American Society of Echocardiography, 2014Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Giuseppe Barletta, Jeanlouis Vanoverschelde, Christian Greis, Stephan Von Bardeleben, Harald BecherAbstract:Background: Contrast Echocardiography improves accuracy and reduces interreader variability on left ventricular (LV)functional analyses inthe settingof two-dimensional (2D) Echocardiography. Theneedfor contrast imaging using three-dimensional (3D) Echocardiography is less defined. The aim of this multicenter study was to define the accuracy and interreader agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography for the assessment of LV volumes and ejection fraction (EF). Methods: A multicenter, open-label study was conducted including 63 patients, using intrasubject comparisons to assess the agreement of unenhanced and contrast-enhanced 2D and 3D Echocardiography as well as calibrated biplane cine ventriculography with cardiac magnetic resonance for the determination of LV volumes and EF. Each of the imaging techniques used to define LV function was assessed by two independent, off-site readers unaware of the results of the other imaging techniques. Results: LV end-systolic and end-diastolic volumes were underestimated by 2D and 3D unenhanced Echocardiography compared with cardiac magnetic resonance. Contrast enhancement resulted in similar significant increases in LV volumes on 2D and 3D Echocardiography. The mean percentage of interreader variability for LV EF was reduced from 14.3% (95% confidence interval [CI], 11.7%‐16.8%) for unenhanced 2D Echocardiography and 14.3% (95% CI, 9.7%‐18.9%) for unenhanced 3D Echocardiography to 8.0% (95% CI, 6.3%‐ 9.7%; P < .001) for contrast-enhanced 2D Echocardiography and 7.4% (95% CI, 5.7%‐9.1%; P < .01) for contrast-enhanced 3D Echocardiography and thus to a similar level as for cardiac magnetic resonance (7.9%; 95% CI, 5.4%‐10.5%). A similar effect was observed for interreader variability for LV volumes. Conclusions: Contrast administration on 3D Echocardiography results in improved determination of LV volumes and reduced interreader variability. The use of 3D Echocardiography requires contrast application as much as 2D Echocardiography to reduce interreader variability for volumes and EF. (J Am Soc Echocardiogr 2014;27:292-301.)
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analysis of regional left ventricular function by cineventriculography cardiac magnetic resonance imaging and unenhanced and contrast enhanced Echocardiography a multicenter comparison of methods
Journal of the American College of Cardiology, 2006Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Stefan Von Bardeleben, Folkert Ten J Cate, Adrian C Borges, Christian Firschke, Stephane Lafitte, Nidal Alsaadi, Stephanie Kuntzhehner, Georg HorstickAbstract: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. lnterobserver agreement on RWMA and accuracy to detect panel-defined RWMA is good using contrast Echocardiography.
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assessment of systolic left ventricular function a multi centre comparison of cineventriculography cardiac magnetic resonance imaging unenhanced and contrast enhanced Echocardiography
European Heart Journal, 2005Co-Authors: Rainer Hoffmann, Jaroslaw D Kasprzak, Stefan Von Bardeleben, Folkert Ten J Cate, Adrian C Borges, Christian Firschke, Stephane Lafitte, Nidal Alsaadi, Stephanie Kuntzhehner, Marc EngelhardtAbstract:Aims To assess the agreement of left ventricular ejection fraction (LVEF) determinations from unenhanced Echocardiography, contrast-enhanced Echocardiography, magnetic resonance imaging (MRI), and cineventriculography as well as the inter-observer agreement for each method. Methods and results In 120 patients, with evenly distributed EF-groups (G 55, 35-55, L 35%), cineventriculography, unenhanced Echocardiography with second harmonic imaging, and contrast Echocardiography at tow mechanical index with iv administration of SonoVueR were performed. In addition, cardiac MRI at 1.5T using a steady-state free precession sequence was performed in a subset of 55 patients. On-site, and two blinded off-site assessments were performed for unenhanced and contrast Echocardiography, cineventricutography, and MRI according to pre-defined standards. Intra-class correlation coefficients (ICCs) were determined to assess inter-observer reliability between all three readers (i.e. one on-site and two off-site). EF was 56.2 P 18.3% by cineventriculography, 54.1 P 12.9% by MRI, 50.9 P 15.3% by unenhanced Echocardiography, and 54.6 P 16.8% by contrast Echocardiography. Correlation on EF between cineventricutography and Echocardiography increased from 0.72 with unenhanced Echocardiography to 0.83 with contrast Echocardiography (P L 0.05). Similarly, correlation on EF between MRI and Echocardiography increased from 0.60 with unenhanced Echocardiography to 0.77 with contrast Echocardiography (P L 0.05). The inter-observer reliability ICC was 0.91 (95% CI 0.88-0.94) in contrast Echocardiography, followed by cardiac MRI (0.86; 95% CI 0.80-0.92), cineventricutography (0.80; 95% CI 0.74-0.85), and unenhanced Echocardiography (0.79; 95% CI 0.74-0.85). Conclusions Unenhanced Echocardiography resulted in slight underestimation of EF and only moderate correlation compared with cineventriculography and MRI. Contrast Echocardiography resulted in more accurate EF and significantly improved correlation with cineventriculography and MRI. Contrast Echocardiography significantly improved inter-observer agreement on EF compared with unenhanced Echocardiography. Interobserver reliability on EF using contrast Echocardiography reaches a level comparable to MRI and is better than those obtained by cineventriculography.
