Gnanappa Ganesh Kumar, Rashid Imran, Celermajer David, Ayer Julian, Puranik Rajesh
Paediatrics, The Heart Centre for Children, The Children's Hospital at Westmead and Cardiac MRI, Cardiovascular Magnetic Resonance, Sydney, NSW, Australia.
Cardiovascular Magnetic Resonance, Sydney, NSW, Australia.
Heart Lung Circ. 2018 Mar;27(3):381-385. doi: 10.1016/j.hlc.2017.04.017. Epub 2017 Jun 3.
Quantification of right ventricular (RV) volumes is challenging owing to variable reproducibility and is especially so in congenital heart disease. Cardiac magnetic resonance (CMR) has the ability to more comprehensively survey the entire right ventricle and is currently considered the gold standard.
We aimed to determine the inter-observer reproducibility of CMR-derived RV volumes generated by two independent and experienced (SCMR Level III) observers in Tetralogy of Fallot (ToF) patients with varying degrees of RV dilatation.
We performed a retrospective analysis of 120 consecutive patients with repaired ToF who underwent CMR. Two blinded observers calculated RV volumes in each oblique short axis slice independently. Bland-Altman analysis and inter-observer correlation coefficients (ICC) were assessed.
The coefficients of variation for RV parameters were: 2.9%, 8% and 3.4% for right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF) respectively. For RVEDV the interobserver correlation was 0.992 demonstrating excellent volumetric correlation between observers. The mean difference between the observers for right ventricular end diastolic volume index (RVEDVi) was 2.5ml/m (95% limits of agreement -7.3 to 12.2ml/m). For patients with mild-moderate RV dilatation (RVEDVi <150ml/m) the mean difference of RVEDVi was 1.8ml/m (95% limits of agreement -5.7 to 9.3ml/m). For patients with severe RV dilatation (RVEDVi≥150ml/m) the mean difference was -3.4ml/m (95% limits of agreement -8.6 to 15.4ml/m).
In patients with repaired ToF and variable degrees of RV dilatation, CMR assessment of RV volumes and function has high inter-observer reproducibility. This allows for optimal timing of pulmonary valve replacement, based on progression of RV dilatation over time.
由于可重复性存在差异，右心室（RV）容积的量化具有挑战性，在先天性心脏病中尤其如此。心脏磁共振成像（CMR）能够更全面地观察整个右心室，目前被视为金标准。
我们旨在确定两名独立且经验丰富（心血管磁共振学会III级）的观察者对不同程度右心室扩张的法洛四联症（ToF）患者通过CMR得出的右心室容积的观察者间可重复性。
我们对120例连续接受CMR检查的ToF修复术后患者进行了回顾性分析。两名不知情的观察者独立计算每个斜短轴切片中的右心室容积。评估了布兰德-奥特曼分析和观察者间相关系数（ICC）。
右心室参数的变异系数分别为：右心室舒张末期容积（RVEDV）2.9%、右心室收缩末期容积（RVESV）8%和右心室射血分数（RVEF）3.4%。对于RVEDV，观察者间相关性为0.992，表明观察者之间存在极好的容积相关性。观察者之间右心室舒张末期容积指数（RVEDVi）的平均差异为2.5ml/m²（95%一致性界限为-7.3至12.2ml/m²）。对于轻度至中度右心室扩张（RVEDVi<150ml/m²）的患者，RVEDVi的平均差异为1.8ml/m²（95%一致性界限为-5.7至9.3ml/m²）。对于重度右心室扩张（RVEDVi≥150ml/m²）的患者，平均差异为-3.4ml/m²（95%一致性界限为-8.6至15.4ml/m²）。
在ToF修复术后且右心室扩张程度不同的患者中，CMR对右心室容积和功能的评估具有较高的观察者间可重复性。这有助于根据右心室扩张随时间的进展情况，确定肺动脉瓣置换的最佳时机。
