title: Analysis of regional left ventricular function by cineventriculography, cardiac magnetic resonance imaging, and unenhanced and contrast-enhanced echocardiography: a multicenter comparison of methods.
abstract: 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.
authors.affiliation: University Rheinisch-Westfälischen Technischen Hochschule Aachen, Aachen, Germany. rhoffmann@ukaachen.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Stephan
authors.initials: S
authors.lastname: von Bardeleben
authors.forename: Jaroslaw D
authors.initials: JD
authors.lastname: Kasprzak
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges
authors.forename: Folkert
authors.initials: F
authors.lastname: ten Cate
authors.forename: Christian
authors.initials: C
authors.lastname: Firschke
authors.forename: Stephane
authors.initials: S
authors.lastname: Lafitte
authors.forename: Nidal
authors.initials: N
authors.lastname: Al-Saadi
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kuntz-Hehner
authors.forename: Georg
authors.initials: G
authors.lastname: Horstick
authors.forename: Christian
authors.initials: C
authors.lastname: Greis
authors.forename: Marc
authors.initials: M
authors.lastname: Engelhardt
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
mesh_terms: 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
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride