超声心动图和心脏磁共振成像评估左心室容积：标准与新型半自动方法的实际评估
Assessment of left ventricular volumes with echocardiography and cardiac magnetic resonance imaging: real-life evaluation of standard versus new semiautomatic methods.
作者信息
Aurich Matthias, André Florian, Keller Marius, Greiner Sebastian, Hess Alexander, Buss Sebastian J, Katus Hugo A, Mereles Derliz
机构信息
Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
出版信息
J Am Soc Echocardiogr. 2014 Oct;27(10):1017-24. doi: 10.1016/j.echo.2014.07.006. Epub 2014 Aug 14.
BACKGROUND
Routine quantitative assessment of left ventricular (LV) volumes with echocardiography is hindered by time-consuming methods requiring a manual trace of the LV cavity from two apical two-dimensional planes. Thus, the aim of this study was to evaluate faster new semiautomatic echocardiographic methods that could represent a feasible alternative for the assessment of LV volumes and ejection fraction (EF) in clinical practice.
METHODS
Two semiautomatic methods, the automated EF (Auto-EF) for two-dimensional echocardiography and the 4D Auto LVQ tool for three-dimensional echocardiography (3DE), were compared with the biplane modified Simpson's method and cardiac magnetic resonance (CMR) imaging in 47 patients. To evaluate the accuracy of volumetry, additional in vitro measurements using water-filled latex balloons were performed with both modalities.
RESULTS
Results of balloon volumetry by echocardiography and CMR measurements were in good agreement with real balloon volumes. The mean LV EF was 45 ± 11% by Auto-EF, 45 ± 11% by 3DE, 48 ± 11% by Simpson's method, and 54 ± 12% by CMR. Linear regression and Bland-Altman analyses showed good associations for semiautomatic methods with Simpson's method (Auto-EF, r = 0.85, bias = 3%, limits of agreement [LOA] = 12%; 3DE, r = 0.79, bias = 3%, LOA = 14%), as well as with CMR (Auto-EF, r = 0.74, bias = 9%, LOA = 17%; 3DE, r = 0.73, bias = 9%, LOA = 17%). Intra- and interobserver variability were 6% and 12% with Auto-EF and 8% and 11% with 3DE, respectively.
CONCLUSIONS
Good correlations between semiautomatic echocardiographic parameters for assessment of LV volumes and EF could be observed when compared with Simpson's method or CMR. However, intertechnique agreement analysis of absolute LV volumes revealed considerable differences, with significant underestimation of volumes and EF with respect to CMR.
背景
超声心动图对左心室（LV）容积进行常规定量评估受到耗时方法的阻碍，这些方法需要从两个心尖二维平面手动描绘LV腔。因此，本研究的目的是评估更快的新型半自动超声心动图方法，这些方法可作为临床实践中评估LV容积和射血分数（EF）的可行替代方法。
方法
将两种半自动方法，即二维超声心动图的自动EF（Auto-EF）和三维超声心动图（3DE）的4D自动LVQ工具，与双平面改良Simpson法和心脏磁共振（CMR）成像在47例患者中进行比较。为了评估容积测量的准确性，两种方法均使用充水乳胶气球进行了额外的体外测量。
结果
超声心动图和CMR测量的气球容积测量结果与实际气球容积高度一致。通过Auto-EF测得的平均LV EF为45±11%，通过3DE测得为45±11%，通过Simpson法测得为48±11%，通过CMR测得为54±12%。线性回归和Bland-Altman分析显示半自动方法与Simpson法（Auto-EF，r = 0.85，偏差 = 3%，一致性界限[LOA] = 12%；3DE，r = 0.79，偏差 = 3%，LOA = 14%）以及与CMR（Auto-EF，r = 0.74，偏差 = 9%，LOA = 17%；3DE，r = 0.73，偏差 = 9%，LOA = 17%）之间具有良好的相关性。观察者内和观察者间的变异性，Auto-EF分别为6%和12%，3DE分别为8%和11%。
结论
与Simpson法或CMR相比，评估LV容积和EF的半自动超声心动图参数之间具有良好的相关性。然而，绝对LV容积的技术间一致性分析显示存在相当大的差异，相对于CMR，容积和EF存在明显低估。
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