观察者依赖性对左心室肥厚小梁质量测量的影响及其与左心室容量和射血分数的关系 - 手动和半自动 CMR 图像分析方法的比较。
Influence of observer-dependency on left ventricular hypertrabeculation mass measurement and its relationship with left ventricular volume and ejection fraction - comparison between manual and semiautomatic CMR image analysis methods.
机构信息
Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
Department of Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland.
出版信息
PLoS One. 2020 Mar 11;15(3):e0230134. doi: 10.1371/journal.pone.0230134. eCollection 2020.
BACKGROUND
Recent studies concerning left ventricular noncompaction (LVNC) suggest that the extent of left ventricular (LV) hypertrabeculation has no impact on prognosis. The variety of methods of LV noncompacted myocardial mass (NCM) assessment may influence the results. Hence, we compared two methods of NCM estimation: largely observer-independent Hautvast's(H) computed algorithm-based approach and commonly used Jacquier's(J) method, and their associations with LV end-diastolic volume (EDV) and ejection fraction (EF).
METHODS
Cardiac magnetic resonance images of 77 persons (45±17yo) - 42 LVNC, 15 non-ischemic dilative cardiomyopathy, 20 control group were analyzed. LVNC patients were divided into the subgroup with normal (LVNCN) and high EDV (LVNCDCM). NCM and total left ventricular mass (LVM) were estimated by Hautvast's [excluding intertrabecular blood (ITB) and including papillary muscles (PMs) into NCM] and Jacquier's approach (including ITB and PMs, if unclearly distinguished, into NCM).
RESULTS
The cut-off value of NCM for LVNC diagnosis was 22% (AUC 0.933) for NCMH/LVMH and 26% (AUC 0.883) for NCMJ/LVMJ. Inter- and intra-observer variability (estimated by coefficient of variation [CoV] and intraclass correlation coefficient [ICC]) of NCMH/LVMH appeared better than of NCMJ/LVMJ (CoV 4.3%, ICC 0.981 and CoV 4.9%, ICC 0.978; respectively for NCMH/LVMH, while for NCMJ/LVMJ: CoV 19.7%, ICC 0.15 and CoV 12.9%, ICC 0.504). In LVNCN subgroup, the correlation between EDV and NCMH was stronger than NCMJ (r = 0.677, p<0.001 vs. r = 0.480, p = 0.038; respectively). In LVNC the EDV correlated with NCMH/LVMH (r = 0.391, p<0.01), but not with NCMJ/LVMJ. In the overall group a relationship was present between EF and NCMH/LVMH (r = -0.449, p<0.001), but not NCMJ/LVMJ. Only NCMH/LVMH explained the variability of EDV (b 0.434, p<0.001).
CONCLUSIONS
Choosing a method of NCM assessment that is less observer-dependent might increase the reliability of results. The impact of method selection on the LV parameters and cut-off values for hypertrabeculation should be further investigated.
背景
最近有关左心室心肌致密化不全（LVNC）的研究表明，左心室（LV）心肌肥厚的程度对预后没有影响。评估 LV 非致密心肌质量（NCM）的方法多种多样，可能会影响结果。因此，我们比较了两种 NCM 评估方法：Hautvast 的（H）基于计算算法的方法，该方法观察者独立性较强，以及常用的 Jacquier 的（J）方法，并比较了它们与 LV 舒张末期容积（EDV）和射血分数（EF）的相关性。
方法
分析了 77 名患者（45±17 岁）的心脏磁共振图像，其中 42 名为 LVNC 患者，15 名为非缺血性扩张型心肌病患者，20 名为对照组。将 LVNC 患者分为 EDV 正常（LVNCN）和 EDV 升高（LVNCDCM）亚组。通过 Hautvast 的方法（不包括小梁内血液（ITB），将乳头肌（PMs）纳入 NCM）和 Jacquier 的方法（包括 ITB 和 PMs，如果不清楚，则将其纳入 NCM）来评估 NCM 和总左心室质量（LVM）。
结果
对于 LVNC 诊断，NCMH/LVMH 的 NCM 截断值为 22%（AUC 0.933），NCMJ/LVMJ 的截断值为 26%（AUC 0.883）。NCMH/LVMH 的观察者内和观察者间变异性（用变异系数[CoV]和组内相关系数[ICC]估计）优于 NCMJ/LVMJ（CoV 4.3%，ICC 0.981 和 CoV 4.9%，ICC 0.978；分别用于 NCMH/LVMH，而对于 NCMJ/LVMJ：CoV 19.7%，ICC 0.15 和 CoV 12.9%，ICC 0.504）。在 LVNCN 亚组中，EDV 与 NCMH 的相关性强于 NCMJ（r = 0.677，p<0.001 与 r = 0.480，p = 0.038；分别用于 NCMH/LVMH）。在 LVNC 中，EDV 与 NCMH/LVMH 相关（r = 0.391，p<0.01），但与 NCMJ/LVMJ 无关。在总体组中，EF 与 NCMH/LVMH 之间存在相关性（r = -0.449，p<0.001），但与 NCMJ/LVMJ 无关。只有 NCMH/LVMH 可以解释 EDV 的变异性（b 0.434，p<0.001）。
结论
选择观察者依赖性较小的 NCM 评估方法可能会提高结果的可靠性。应进一步研究方法选择对 LV 参数和肥厚小梁的截断值的影响。
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