Nemes Attila, Geleijnse Marcel L, Krenning Boudewijn J, Soliman Osama I I, Anwar Ashraf M, Vletter Wim B, Ten Cate Folkert J
Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands.
Am J Cardiol. 2007 Jan 15;99(2):275-8. doi: 10.1016/j.amjcard.2006.08.023. Epub 2006 Nov 27.
Dobutamine stress echocardiography is an accepted tool for the diagnosis of coronary artery disease. Some investigators have claimed that 3-dimensional imaging improves the diagnostic accuracy of dobutamine stress echocardiography. The purpose of the present investigation was to examine the role of contrast echocardiography in the improvement of segmental quality and interobserver agreement during stress real-time 3-dimensional echocardiography (RT3DE). The study comprised 36 consecutive patients with stable chest pain referred for routine stress testing. Three-dimensional images were acquired with an RT3DE system with an X4 matrix-array transducer. All available reconstructed 2-dimensional segments were graded as optimal, good, moderate, or poor. Wall motion was scored as normal, mild hypokinesia, severe hypokinesia, akinesia, or dyskinesia. At peak stress, 466 of the 612 segments (76%) could be analyzed during conventional RT3DE. With contrast-enhanced RT3DE, the number of available segments increased to 553 (90%). The image quality index during conventional RT3DE was 2.2, whereas with contrast-enhanced RT3DE, it was 3.1. With conventional RT3DE, 2 independent observers agreed on the diagnosis of myocardial ischemia in 85 of 108 coronary territories (79%, kappa = 0.26). With contrast-enhanced RT3DE, agreement increased to 95 of 108 coronary territories (88%, kappa = 0.59). Study agreement on myocardial ischemia was present in 26 of 36 studies (72%, kappa = 0.43) with conventional RT3DE and in 32 of 36 studies (89%, kappa = 0.77) with contrast-enhanced RT3DE. In conclusion, during stress RT3DE, contrast-enhanced imaging significantly decreases the number of poorly visualized myocardial segments and improves interobserver agreement for the diagnosis of myocardial ischemia.
多巴酚丁胺负荷超声心动图是诊断冠状动脉疾病的一种公认工具。一些研究人员声称，三维成像可提高多巴酚丁胺负荷超声心动图的诊断准确性。本研究的目的是探讨对比超声心动图在负荷实时三维超声心动图（RT3DE）期间改善节段质量和观察者间一致性方面的作用。该研究纳入了36例因常规负荷试验而转诊的连续性稳定型胸痛患者。使用配备X4矩阵阵列换能器的RT3DE系统采集三维图像。所有可用的重建二维节段被分为最佳、良好、中等或差。壁运动被评为正常、轻度运动减弱、重度运动减弱、运动不能或运动障碍。在负荷峰值时，在传统RT3DE期间，612个节段中的466个（76%）可以进行分析。使用对比增强RT3DE时，可用节段数量增加到553个（90%）。传统RT3DE期间的图像质量指数为2.2，而对比增强RT3DE时为3.1。使用传统RT3DE时，2名独立观察者在108个冠状动脉节段中的85个（79%，kappa = 0.26）上对心肌缺血的诊断达成一致。使用对比增强RT3DE时，一致性提高到108个冠状动脉节段中的95个（88%，kappa = 0.59）。在26项研究中的36项（72%，kappa = 0.43）中，传统RT3DE对心肌缺血的研究一致性存在，而在对比增强RT3DE的36项研究中的32项（89%，kappa = 0.77）中存在。总之，在负荷RT3DE期间，对比增强成像显著减少了心肌节段显示不佳的数量，并提高了观察者间对心肌缺血诊断的一致性。
