University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, PO box 30.001, 9700 RB, the Netherlands.
University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, PO box 30.001, 9700 RB, the Netherlands.
Eur J Radiol. 2019 May;114:6-13. doi: 10.1016/j.ejrad.2019.02.039. Epub 2019 Feb 28.
This study was designed to investigate the agreement of 2D transthoracic echocardiography (2D TTE) with cardiovascular magnetic resonance imaging (CMR) in a contemporary population of ST-elevation myocardial infarction (STEMI) patients.
In this subanalysis of the GIPS-III trial, a randomized controlled trial investigating the administration of metformin in STEMI patients to prevent reperfusion injury, we studied 259 patients who underwent same-day CMR and 2D TTE assessments four months after hospitalization for a first STEMI. Bland-Altman analyses were performed to assess agreement between LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), and LV mass measurements. Sensitivity and specificity of 2D TTE to detect categories of LVEF (≤35%, 35-50%, ≥50%) was determined. Linear regression of absolute differences in measurements between imaging modalities was used to investigate whether patient characteristics impact measurement bias.
Pairwise difference (bias) and 95% limits of agreement between CMR and 2D TTE measurements were +84 (37, 147) ml for LVEDV, +39 (6, 85) ml for LVESV, -1.1 ± 13.5% for LVEF, and -75 (-154, -14) g for LV mass. Sensitivity and specificity of 2D TTE to detect subjects with moderately depressed LVEF (35-50%) as measured by CMR were 52% and 88% respectively. We observed a significant effect of enzymatic infarct size on bias between 2D TTE and CMR in measuring LVESV and LVEF (P = 0.029, P = 0.001 respectively), of age and sex on bias between 2D TTE and CMR in measuring LV mass (P = 0.027, P < 0.001) and LVEDV (P = 0.001, P = 0.039), and of heart rate on bias between 2D TTE and CMR in LV volume measurements (P = 0.004, P = 0.016).
Wide limits of agreement, underestimation of LV volumes and overestimation of LV mass was observed when comparing 2D TTE to CMR. Enzymatic infarct size, age, sex, and heart rate are potential sources of bias between imaging modalities.
本研究旨在调查二维经胸超声心动图（2D TTE）与心血管磁共振成像（CMR）在当代 ST 段抬高型心肌梗死（STEMI）患者中的一致性。
在 GIPS-III 试验的这项亚分析中，我们研究了 259 名患者，他们在因首次 STEMI 住院 4 个月后同一天接受了 CMR 和 2D TTE 评估。进行 Bland-Altman 分析以评估 LV 舒张末期容积（LVEDV）、LV 收缩末期容积（LVESV）、LV 射血分数（LVEF）和 LV 质量测量之间的一致性。确定 2D TTE 检测 LVEF（≤35%、35-50%、≥50%）类别灵敏度和特异性。使用成像方式之间的绝对差异的线性回归来研究患者特征是否会影响测量偏差。
CMR 和 2D TTE 测量值之间的配对差值（偏差）和 95%一致性界限分别为 LVEDV 为+84（37，147）ml，LVESV 为+39（6，85）ml，LVEF 为-1.1±13.5%，LV 质量为-75（-154，-14）g。2D TTE 检测 CMR 中度降低的 LVEF（35-50%）的灵敏度和特异性分别为 52%和 88%。我们观察到酶性梗死面积对 2D TTE 和 CMR 在测量 LVESV 和 LVEF 时的偏差有显著影响（P=0.029，P=0.001），年龄和性别对 2D TTE 和 CMR 在测量 LV 质量（P=0.027，P<0.001）和 LVEDV（P=0.001，P=0.039）时的偏差有显著影响，心率对 2D TTE 和 CMR 在 LV 容积测量中的偏差有显著影响（P=0.004，P=0.016）。
与 CMR 相比，观察到 2D TTE 的 LV 容积测量值存在较大的一致性界限、低估和 LV 质量高估。酶性梗死面积、年龄、性别和心率是成像方式之间产生偏差的潜在来源。
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