Inherited Cardiac Diseases Unit & Heart Failure Unit, Guy's & St. Thomas' NHS Trust Foundation Trust, London, United Kingdom; Inherited Cardiac Diseases Unit and Cardiovascular Imaging Laboratory, Vall d'Hebron University Hospital, Barcelona, Spain.
Cardiovascular Imaging Laboratory, Malaga Regional University Hospital, Malaga, Spain.
J Am Soc Echocardiogr. 2020 Sep;33(9):1106-1115. doi: 10.1016/j.echo.2020.04.009. Epub 2020 Jun 18.
Left ventricular wall thickness (LVWT) measurement is key in the diagnostic and prognostic assessment of hypertrophic cardiomyopathy (HCM). Recent investigations have highlighted discrepancies in LVWT by cardiac magnetic resonance (CMR) and standard echocardiography (S-Echo) in this condition. The aim of this study was to elucidate the role of contrast-enhanced echocardiography (C-Echo) to optimize LVWT measurement in patients with HCM.
Fifty patients with HCM were prospectively enrolled, undergoing S-Echo, C-Echo, and CMR. Blinded LVWT measurements were performed according to a 16-segment left ventricular model using all three imaging techniques. Agreement between both echocardiographic modalities and CMR (as the reference technique) at the segmental level was tested using Bland-Altman analyses. Reproducibility on segmental measurements by S-Echo and C-Echo was also investigated.
Patients' mean age was 47 ± 21 years, and 35 (70%) were men. Maximal mean LVWT by S-Echo (20.1 ± 3.8 mm) was greater than the values derived using C-Echo (17.6 ± 4.0 mm, P < .01) and CMR (17.7 ± 4.5 mm, P < .01), with no statistically significant difference between the latter two. Segmental Bland-Altman models demonstrated globally smaller bias and narrower 95% limits of agreement for C-Echo compared with S-Echo. Across all left ventricular segments, LVWT by C-Echo was 2.4 mm lower (range, 1.0-2.5 mm) than that derived by S-Echo, which accounted for a 25% intertechnique difference. Regarding maximal LVWT, the mean absolute difference between C-Echo and S-Echo was 3.0 ± 1.9 mm (range, 0.0-7.9 mm), which represented a 15% intertechnique change. Data analyses demonstrated globally less intra- and interobserver variability in segmental LVWT derived from C-Echo compared with S-Echo.
C-Echo rendered LVWT measurements closer to those derived by the reference technique (CMR) and improved reproducibility compared with S-Echo. C-Echo represents a suitable tool for LVWT measurement in patients with HCM as an alternative to CMR whenever this is not available or possible.
左心室壁厚度（LVWT）的测量在肥厚型心肌病（HCM）的诊断和预后评估中至关重要。最近的研究强调了在这种情况下，心脏磁共振（CMR）和标准超声心动图（S-Echo）测量 LVWT 的差异。本研究旨在阐明对比增强超声心动图（C-Echo）在优化 HCM 患者 LVWT 测量中的作用。
前瞻性纳入 50 例 HCM 患者，行 S-Echo、C-Echo 和 CMR 检查。使用所有三种成像技术，根据 16 节段左心室模型进行盲法 LVWT 测量。使用 Bland-Altman 分析测试两种超声心动图方法与 CMR（作为参考技术）在节段水平上的一致性。还研究了 S-Echo 和 C-Echo 在节段测量上的可重复性。
患者的平均年龄为 47±21 岁，35 名（70%）为男性。S-Echo 测量的最大平均 LVWT（20.1±3.8mm）大于 C-Echo（17.6±4.0mm，P<.01）和 CMR（17.7±4.5mm，P<.01），后两者之间无统计学差异。节段 Bland-Altman 模型显示，与 S-Echo 相比，C-Echo 的全局偏差更小，95%一致性界限更窄。在所有左心室节段中，C-Echo 测量的 LVWT 比 S-Echo 低 2.4mm（范围，1.0-2.5mm），这解释了两种技术之间 25%的差异。关于最大 LVWT，C-Echo 与 S-Echo 之间的平均绝对差值为 3.0±1.9mm（范围，0.0-7.9mm），这代表了两种技术之间 15%的变化。数据分析显示，与 S-Echo 相比，C-Echo 测量的节段 LVWT 的全局内和观察者间变异性更小。
C-Echo 使 LVWT 测量结果更接近参考技术（CMR），与 S-Echo 相比，重复性更好。在无法获得或不可能获得 CMR 时，C-Echo 是一种替代 CMR 测量 HCM 患者 LVWT 的合适工具。
