Franke A, Hoffmann R, Kühl H P, Lepper W, Breithardt O A, Schormann M, Hanrath P
Medical Clinic I, University Hospital, Pauwelsstrasser 30, D 52057 Aachen, Germany.
Heart. 2000 Feb;83(2):133-40. doi: 10.1136/heart.83.2.133.
To examine the influence of second harmonic imaging during dobutamine echocardiography on regional endocardial visibility, interobserver agreement in the interpretation of wall motion abnormalities, and diagnostic accuracy in patients with reduced image quality.
Blinded comparison.
Tertiary care centre.
103 consecutive patients with suspected coronary artery disease and impaired transthoracic image quality (>/= 2 segments with poor endocardial delineation).
Fundamental and second harmonic imaging were performed at each stage of a dobutamine stress echocardiography. Coronary angiography was undertaken within three weeks of dobutamine echocardiography in 75 patients.
Evaluation of regional endocardial visibility (scoring from 0 = poor to 2 = good) and of segmental wall motion abnormalities for both modalities separately. A second blinded examiner analysed 70 studies to determine interobserver agreement.
Mean (SD) visibility score for all segments was 1.2 (0.4) using fundamental imaging and 1.7 (0.2) using second harmonic imaging at rest (p < 0.001), and 1.1 (0.4) v 1.6 (0.3), respectively, at peak dobutamine dose (p < 0.001). The average number of segments with poor endocardial visibility was lower for second harmonic than for fundamental imaging (0.6 (1.1) v 3.8 (2.6) at rest, p < 0.001; 0.9 (1.3) v 4.3 (2.9) at peak dose, p < 0.001). Improvement was most pronounced in all lateral and anterior segments. The kappa value for identical study interpretation increased from 0. 40 to 0.69 (p < 0.05). Sensitivity for the diagnosis of coronary artery disease was 64% using fundamental imaging versus 92% using harmonic imaging (p < 0.001), while specificity remained unchanged at 75% for both imaging modalities.
Second harmonic imaging enhances endocardial visibility during dobutamine echocardiography. Consequently, interobserver agreement on stress echocardiography interpretation and diagnostic accuracy are significantly improved compared to fundamental imaging. Thus, in difficult to image patients, dobutamine echocardiography should be performed using second harmonic imaging.
研究多巴酚丁胺超声心动图检查中二次谐波成像对局部心内膜显示、观察者间对室壁运动异常判读的一致性以及图像质量降低患者诊断准确性的影响。
盲法比较。
三级医疗中心。
103例连续入选的疑似冠心病且经胸图像质量受损（心内膜轮廓不清的节段≥2个）的患者。
在多巴酚丁胺负荷超声心动图检查的每个阶段同时进行基波成像和二次谐波成像。75例患者在多巴酚丁胺超声心动图检查后3周内接受冠状动脉造影。
分别评估两种成像方式下局部心内膜的显示情况（评分从0分=差至2分=好）以及节段性室壁运动异常情况。另一位盲法检查者分析70份研究结果以确定观察者间的一致性。
静息状态下，所有节段的平均（标准差）显示评分在基波成像时为1.2（0.4）分，二次谐波成像时为1.7（0.2）分（p<0.001）；在多巴酚丁胺峰值剂量时，分别为1.1（0.4）分和1.6（0.3）分（p<0.001）。二次谐波成像时心内膜显示不佳的节段平均数量低于基波成像（静息时为0.6（1.1）个对3.8（2.6）个，p<0.001；峰值剂量时为0.9（1.3）个对4.3（2.9）个，p<0.001）。改善最明显的是所有侧壁和前壁节段。相同研究判读结果的kappa值从0.40增至0.69（p<0.05）。基波成像诊断冠心病的敏感性为64%，二次谐波成像为92%（p<0.001），而两种成像方式的特异性均保持在75%不变。
二次谐波成像可提高多巴酚丁胺超声心动图检查时的心内膜显示。因此，与基波成像相比，观察者间对负荷超声心动图判读的一致性和诊断准确性均显著提高。所以，对于难以成像的患者，应采用二次谐波成像进行多巴酚丁胺超声心动图检查。
