title: Analysis of myocardial perfusion or myocardial function for detection of regional myocardial abnormalities. An echocardiographic multicenter comparison study using myocardial contrast echocardiography and 2D echocardiography.
abstract: BACKGROUND
  Echocardiography based myocardial perfusion imaging and regional wall motion analysis are used for evaluation of coronary artery disease and regional myocardial abnormalities.
  
  
  OBJECTIVE
  This study sought to compare myocardial contrast echocardiography (MCE) and 2D echocardiography with regard to interobserver variability and detection of regional myocardial abnormalities.
  
  
  METHODS
  In 70 patients evenly distributed between three ejection fraction groups based on biplane cineventriculography ( > 55%, 35-55%, < 35%), unenhanced and contrast enhanced 2D echocardiography and myocardial contrast echocardiography (MCE; SonoVue; Bracco) were performed. Regional wall motion and myocardial perfusion were assessed referring to a 16 segment model. Interobserver agreement (IOA) among 2 readers was determined within each imaging modality. To define a standard of truth for the presence of segmental myocardial disease an independent expert-panel decision was obtained based on clinical data, ECG, coronary angiography and blinded information from the imaging modalities.
  
  
  RESULTS
  Regional wall motion assessment was possible in 98.1% of segments using contrast enhanced 2D echocardiography and in 87.2% using unenhanced 2D echocardiography (p < 0.001), while perfusion assessment was possible in 90.1% of segments (p < 0.001). IOA on presence of any regional wall motion abnormality expressed as Kappa coefficient was 0.71 (95% CI 0.53-0.89) for contrast enhanced echocardiography and 0.37 (95% CI 0.14-0.59) for unenhanced echocardiography. IOA on presence of any perfusion abnormality was 0.53 (95% CI 0.34-0.73). For MCE there was high IOA for the apical segments (kappa = 0.57) and lower IOA for the basal segments (kappa=0.14), while no such gradient was found for the IOA on wall motion abnormalities. Mean accuracy to detect expert-panel defined myocardial abnormalities was 80.6% for unenhanced echocardiography, 85.0% for contrast enhanced 2D echocardiography and 80.6% for MCE.
  
  
  CONCLUSIONS
  MCE is inferior to contrast enhanced 2D echocardiography with regard to visibility of all LV segments and appears slightly inferior with regards to IOA, while both are superior to unenhanced 2D echocardiography. The methods demonstrated high accuracy in detection of panel defined regional myocardial abnormalities.
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. rhoffmann@ukaachen.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges
authors.forename: Jaroslaw D
authors.initials: JD
authors.lastname: Kasprzak
authors.forename: Stephan
authors.initials: S
authors.lastname: von Bardeleben
authors.forename: Christian
authors.initials: C
authors.lastname: Firschke
authors.forename: Christian
authors.initials: C
authors.lastname: Greis
authors.forename: Marc
authors.initials: M
authors.lastname: Engelhardt
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Vanoverschelde
mesh_terms: D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D003287:Contrast Media