Kussmaul W G, Kleaveland J P, Zeevi G R, Hirshfeld J W
Cardiac Catheterization Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104.
Cathet Cardiovasc Diagn. 1990 Jul;20(3):153-64. doi: 10.1002/ccd.1810200302.
To evaluate the accuracy of angiographic methods for analysis of left ventricular regional wall motion, we measured the ability of a carefully performed subjective analysis (three independent observers) and that of three computer-assisted methods (centerline, radial, and area) to detect the presence of significant coronary artery disease. Normal ranges were established in 90 studies showing normal wall motion, and accuracy was tested in a second, consecutive series of 43 ventriculograms. The results show that the subjective method best separated those regions with from those without significant coronary disease. The subjective method also demonstrated sensitivity comparable to the centerline and radial methods. Among the computer-assisted methods, the area method was least sensitive but most specific for both anterior and inferior region coronary disease. The centerline and radial methods were highly sensitive, but less specific. When coronary disease was defined by electrocardiographic Q-waves, the area method had superior accuracy. Further analysis showed the following: 1) For the centerline and radial methods, long-axis reregistration of the end-systolic frame resulted in loss of sensitivity but increased specificity for anterior wall coronary disease, and little change in analysis of the inferior wall; 2) inclusion or exclusion of the apex had little effect on predictive accuracy for anterior wall coronary disease; 3) as expected, sensitivity and specificity results of all methods were dependent on the selection of a normal range cutoff value; but when performance was optimized, the subjective and area methods had a higher overall predictive accuracy than the centerline method; 4) It is likely that all three computer-assisted methods could be calibrated to give indications of degrees of hypokinesis, as their results correlated well with subjective observers' evaluations over the entire range of scores. These results should assist in selection of the optimal method for regional wall motion analysis in clinical and research applications. As currently applied, the area method is the most specific of the computer-assisted methods tested; the centerline and radial methods have highest sensitivity and therefore are most suited to detection of mild degrees of hypokinesis.
为评估血管造影方法分析左心室局部室壁运动的准确性，我们测量了精心实施的主观分析方法（三位独立观察者）以及三种计算机辅助方法（中心线法、径向法和面积法）检测显著冠状动脉疾病的能力。在90项显示室壁运动正常的研究中确定了正常范围，并在连续的43项心室造影的第二个系列中测试了准确性。结果显示，主观方法能最好地区分有显著冠状动脉疾病和无显著冠状动脉疾病的区域。主观方法还显示出与中心线法和径向法相当的敏感性。在计算机辅助方法中，面积法对前壁和下壁冠状动脉疾病的敏感性最低，但特异性最高。中心线法和径向法敏感性高，但特异性较低。当根据心电图Q波定义冠状动脉疾病时，面积法具有更高的准确性。进一步分析表明：1）对于中心线法和径向法，收缩末期帧的长轴重新配准导致前壁冠状动脉疾病的敏感性降低，但特异性增加，而下壁分析变化不大；2）包含或排除心尖对前壁冠状动脉疾病的预测准确性影响不大；3）正如预期的那样，所有方法的敏感性和特异性结果取决于正常范围截断值的选择；但当性能优化时，主观方法和面积法的总体预测准确性高于中心线法；4）很可能所有三种计算机辅助方法都可以进行校准，以给出运动减弱程度的指示，因为它们的结果在整个评分范围内与主观观察者的评估相关性良好。这些结果应有助于在临床和研究应用中选择用于局部室壁运动分析的最佳方法。就目前的应用而言，面积法是所测试的计算机辅助方法中最具特异性的；中心线法和径向法敏感性最高，因此最适合检测轻度运动减弱。
