Nazarbayev University School of Medicine, Astana, Kazakhstan.
National Research Cardiac Surgery Center, Astana, Kazakhstan.
PLoS One. 2024 Jul 25;19(7):e0306481. doi: 10.1371/journal.pone.0306481. eCollection 2024.
Hemodynamic forces (HDF) analysis has been proposed as a method to quantify intraventricular pressure gradients, however data on its reliability are still scanty. Thus, the aim of this study is to assess the reliability of HDF parameters derived from cardiac magnetic resonance (CMR).
CMR studies of 25 athletes were analysed by two independent observers and then re-analysed by the same observer one week apart. Intraclass Correlation Coefficient (ICC [95% CI]) and Bland-Altman plots were used to assess association, agreement, and bias of the longitudinal (A-B) HDF, transverse (L-S) HDF, and Impulse Angle. The sample size required to detect a relative change in the HDF parameters was also calculated.
In terms of inter-observer variability, there was a good correlation for the A-B and L-S (ICC 0.85 [0.67-0.93] and 0.86 [0.69-0.94]; p<0.001 for both, respectively) and a moderate correlation for the Impulse Angle (ICC 0.73 [0.39-0.87]; p = 0.001). For intra-observer variability, A-B and L-S showed excellent correlation (ICC 0.91 [0.78-0.93] and 0.93 [0.83-0.97]; p<0.001 for both, respectively). Impulse Angle presented good correlation (ICC 0.80 [0.56-0.90]; p<0.001). Frame selection and aortic valve area measurements were the most vulnerable step in terms of reliability of the method. Sample size calculation to detect relative changes ranged from n = 1 to detect a 15% relative change in Impulse Angle to n = 171 for the detection of 10% relative change in A-B HDF.
The results of this study showed a low inter- and intra-observer variability of HDF parameters derived from feature-tracking CMR. This provides the fundamental basis for their use both in research and clinical practice, which could eventually lead to the detection of significant changes at follow-up studies.
血流动力（HDF）分析已被提议作为量化心室压力梯度的一种方法，然而，关于其可靠性的数据仍然很少。因此，本研究的目的是评估从心脏磁共振（CMR）得出的 HDF 参数的可靠性。
对 25 名运动员的 CMR 研究进行了由两位独立观察者进行分析，然后由同一位观察者在一周后进行再次分析。使用组内相关系数（ICC[95%CI]）和 Bland-Altman 图来评估纵向（A-B）HDF、横向（L-S）HDF 和脉冲角的相关性、一致性和偏差。还计算了检测 HDF 参数相对变化所需的样本量。
在观察者间变异性方面，A-B 和 L-S 之间存在良好的相关性（ICC 分别为 0.85[0.67-0.93]和 0.86[0.69-0.94]；p<0.001），而脉冲角的相关性为中度（ICC 0.73[0.39-0.87]；p=0.001）。对于观察者内变异性，A-B 和 L-S 显示出极好的相关性（ICC 分别为 0.91[0.78-0.93]和 0.93[0.83-0.97]；p<0.001）。脉冲角的相关性良好（ICC 0.80[0.56-0.90]；p<0.001）。在方法可靠性方面，帧选择和主动脉瓣口面积测量是最脆弱的步骤。检测相对变化的样本量计算范围从 n=1 检测脉冲角的 15%相对变化到 n=171 检测 A-B HDF 的 10%相对变化。
本研究的结果显示，从特征追踪 CMR 得出的 HDF 参数的观察者间和观察者内变异性较低。这为其在研究和临床实践中的应用提供了基本依据，最终可能导致在随访研究中检测到显著变化。
