心肌梗死后测量左心室容积的最佳临床技术是什么？三维超声心动图、单光子发射计算机断层扫描和心脏磁共振成像的比较研究。
What is the optimal clinical technique for measurement of left ventricular volume after myocardial infarction? A comparative study of 3-dimensional echocardiography, single photon emission computed tomography, and cardiac magnetic resonance imaging.
作者信息
Chan Jonathan, Jenkins Carly, Khafagi Frederick, Du Leanne, Marwick Thomas H
机构信息
University of Queensland, Brisbane, Australia.
出版信息
J Am Soc Echocardiogr. 2006 Feb;19(2):192-201. doi: 10.1016/j.echo.2005.08.020.
BACKGROUND
Left ventricular (LV) volumes have important prognostic implications, but are commonly underestimated. We sought accuracy and reproducibility of LV volume measurement by live 3-dimensional (3D) echocardiography (3DE) and TI-201 single photon emission computed tomography (SPECT), compared with cardiac magnetic resonance imaging (MRI).
METHODS
In all, 30 patients (age 62 +/- 9 years, 23 men) underwent LV volume assessment with 3DE, SPECT, and cardiac MRI after myocardial infarction. LV volumes were measured using a semiautomated border detection algorithm for 3DE, gated SPECT software for SPECT, and a 3D display for MRI. Results of 3DE and SPECT volumes were compared with MRI as the standard of reference.
RESULTS
The 3DE volumes showed excellent correlation with cardiac MRI (end-diastolic volume [EDV], r = 0.90, P = .001; end-systolic volume [ESV], r = 0.94, P = .001), as did SPECT (EDV, r = 0.89, P = .001; ESV, r = 0.95, P = .001). However, both 3DE and SPECT underestimated LV volumes. The mean MRI EDV was 179 +/- 56 mL compared with 3DE (mean difference, -10 +/- 26 mL, P = .04) and SPECT (mean difference, -58 +/- 28 mL, P < .001). There was a significant difference between SPECT EDV and 3DE (mean difference, -48 +/- 31 mL, P < .001). The mean MRI ESV was 96 +/- 54 mL and this was underestimated by SPECT (mean difference, -22 +/- 19 mL, P < .001), but not by 3DE (mean difference, -0.9 +/- 19 mL, P = not significant). ESV was also underestimated when SPECT was compared with 3DE (mean difference, -22 +/- 27 mL, P < .001). The results of 3DE were reproducible with excellent intraobserver (ESV, r = 0.98, -2 +/- 6 mL; EDV, r = 0.98, -1 +/- 6 mL, P = .001) and interobserver (ESV, r = 0.97, -2 +/- 6 mL; EDV, r = 0.95, -3 +/- 10 mL, P = .001) correlation.
CONCLUSION
We have shown that 3DE is accurate and reproducible for the measurement of LV volumes for risk assessment in chronic ischemic heart disease and dilated cardiomyopathy. Furthermore, 3DE is more accurate than TI-201 SPECT with less underestimation of LV volumes.
背景
左心室（LV）容积具有重要的预后意义，但通常被低估。我们旨在通过实时三维（3D）超声心动图（3DE）和TI - 201单光子发射计算机断层扫描（SPECT）测量LV容积的准确性和可重复性，并与心脏磁共振成像（MRI）进行比较。
方法
总共30例患者（年龄62±9岁，23例男性）在心肌梗死后接受了3DE、SPECT和心脏MRI的LV容积评估。使用半自动边界检测算法测量3DE的LV容积，使用门控SPECT软件测量SPECT的LV容积，并使用3D显示器测量MRI的LV容积。将3DE和SPECT容积的结果与作为参考标准的MRI进行比较。
结果
3DE容积与心脏MRI显示出极好的相关性（舒张末期容积[EDV]，r = 0.90，P = 0.001；收缩末期容积[ESV]，r = 0.94，P = 0.001），SPECT也是如此（EDV，r = 0.89，P = 0.001；ESV，r = 0.95，P = 0.001）。然而，3DE和SPECT均低估了LV容积。MRI的平均EDV为179±56 mL，而3DE为（平均差异，-10±26 mL，P = 0.04），SPECT为（平均差异，-58±28 mL，P < 0.001）。SPECT的EDV与3DE之间存在显著差异（平均差异，-48±31 mL，P < 0.001）。MRI的平均ESV为96±54 mL，SPECT低估了该值（平均差异，-22±19 mL，P < 0.001），但3DE未低估（平均差异，-0.9±19 mL，P = 无显著意义）。当SPECT与3DE比较时，ESV也被低估（平均差异，-22±27 mL，P < 0.001）。3DE的结果具有可重复性，观察者内（ESV，r = 0.98，-2±6 mL；EDV，r = 0.98，-1±6 mL，P = 0.001）和观察者间（ESV，r = 0.97，-2±6 mL；EDV，r = 0.95，-3±10 mL，P = 0.001）相关性良好。
结论
我们已经表明，3DE对于慢性缺血性心脏病和扩张型心肌病风险评估中LV容积的测量是准确且可重复的。此外，3DE比TI - 201 SPECT更准确，对LV容积的低估更少。
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