Fernández Portales J, García Fernández M A, Moreno M, González Alujas M T, Placer J L, Allue C, Bermejo J, Delcán J L
Hospital General Universitario Gregorio Marañón. Madrid.
Rev Esp Cardiol. 2000 Nov;53(11):1459-66. doi: 10.1016/s0300-8932(00)75264-x.
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.
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.
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.
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.
本研究旨在确定更新的技术是否能显著改善声学窗口欠佳情况下的心内膜边界清晰度，以及根据不同技术和专业程度对室壁运动异常评估的可重复性。
我们共研究了20例连续的超声窗口欠佳的患者，以评估使用组织谐波成像（2H）或二次谐波造影剂（声诺维；静脉注射4g）（2HC）是否能改善心内膜边界的可视化。为了分析不同技术在观察者间和观察者内的可靠性，邀请了四名不同专业程度的观察者分别对31例连续的超声心动图进行节段性室壁运动评分。
与二维（2D）相比，2H和2HC的图像质量明显更优。2H使心尖和侧壁心内膜边界的差异更大，从0.9和1分别提高到1.5和1.64（p<0.001）。与2H相比，2HC在心尖处略微但显著地改善了心内膜清晰度（1.64对1.81；p=0.016）。2H和2HC显著提高了观察者间变异性评估节段的百分比（2D=50%，2H=75%，2HC=95%）。经验丰富的观察者之间不同技术的观察者间一致性在统计学上无差异。经验较少的观察者的观察者间可靠性明显低于有经验的观察者，且2H和2HC并未改善这一情况。
a）天然组织谐波成像和二次谐波造影成像（声诺维）显著改善了心内膜边界的可视化；b）更新的成像技术显著提高了性能（评估节段的百分比）且不降低可靠性，c）评估室壁运动的经验是观察者间一致性的主要因素。
