Analysis of regional left ventricular function by cineventriculography, cardiac magnetic resonance imaging, and unenhanced and contrast-enhanced echocardiography: a multicenter comparison of methods.
OBJECTIVE
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.
Hoffmann
Rainer
R
University Rheinisch-Westfälischen Technischen Hochschule Aachen, Aachen, Germany. rhoffmann@ukaachen.de
von Bardeleben
Stephan
S
Kasprzak
Jaroslaw D
JD
Borges
Adrian C
AC
ten Cate
Folkert
F
Firschke
Christian
C
Lafitte
Stephane
S
Al-Saadi
Nidal
N
Kuntz-Hehner
Stefanie
S
Horstick
Georg
G
Greis
Christian
C
Engelhardt
Marc
M
Vanoverschelde
Jean Louis
JL
Becher
Harald
H
D002933:Cineradiography; D003287:Contrast Media; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006321:Heart; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D010743:Phospholipids; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*; D016277:Ventricular Function, Left
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride