title: [Usefulness of the new imaging techniques, second harmonic and contrast in endocardial border visualization. Reliability analysis in segmental contraction assessment].
abstract: OBJECTIVE
  This study sought to determine if newer techniques significantly improve endocardial border definition in suboptimal acoustic windows, and the reproducibility of the evaluation of wall motion abnormalities according to the different techniques and degrees of expertise.
  
  
  METHODS
  We studied a total of 20 consecutive patients with poor ultrasound window, to assess, if the use of tissue harmonic imaging (2H) or contrast with second harmonic (Levovist ; 4 g i.v.), (2HC) improves endocardial border visualization. In order to analyze inter and intraobserver reliability with the different techniques, four observers with different degrees of expertise were each asked to assess the segmental wall motion score of 31 consecutive echocardiograms.
  
  
  RESULTS
  The quality of the image was clearly superior with 2H and 2HC compared with 2D. This difference was larger in apex and lateral endocardial border from 0.9 and 1 to 1.5 and 1.64 (p < 0.001) with 2H. 2HC was found to slightly but significantly improve the endocardial definition in apex compared with 2H (1.64 vs 1.81; p = 0.016). The percentage of segments assessed for interobserver variability significantly improve with 2H and 2HC (2D = 50%, 2H = 75% and 2HC = 95%). Interobserver agreement with the different techniques between the experienced observers did not statistically differ. The less experienced observer presented a significantly lower interobserver reliability than those with experience, and did not improve with 2H and 2HC.
  
  
  CONCLUSIONS
  a) Native tissue harmonic imaging and second harmonic imaging with contrast (Levovist ) significantly improves endocardial border visualization; b) the newer imaging techniques significantly improve performance (percentage of evaluated segments) without decreasing reliability, and c) experience in assessing wall motion is the main factor in interobserver agreement.
authors.affiliation: Hospital General Universitario Gregorio Marañón. Madrid.
authors.forename: J
authors.initials: J
authors.lastname: Fernández Portales
authors.forename: M A
authors.initials: MA
authors.lastname: García Fernández
authors.forename: M
authors.initials: M
authors.lastname: Moreno
authors.forename: M T
authors.initials: MT
authors.lastname: González Alujas
authors.forename: J L
authors.initials: JL
authors.lastname: Placer
authors.forename: C
authors.initials: C
authors.lastname: Allue
authors.forename: J
authors.initials: J
authors.lastname: Bermejo
authors.forename: J L
authors.initials: JL
authors.lastname: Delcán
mesh_terms: D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data; D004699:Endocardium / Q000000981:diagnostic imaging* / Q000502:physiology; D006801:Humans; D009200:Myocardial Contraction; D015588:Observer Variation; D015203:Reproducibility of Results