与磁共振成像作为参考标准比较，64 排 CT、双平面左心室电影造影和二维及三维经胸超声心动图对左心室功能的头对头比较。
Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard.
机构信息
Department of Radiology, Charité Medical School, Berlin, Germany.
出版信息
J Am Coll Cardiol. 2012 May 22;59(21):1897-907. doi: 10.1016/j.jacc.2012.01.046.
OBJECTIVES
This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI).
BACKGROUND
Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients.
METHODS
A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed.
RESULTS
For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58).
CONCLUSIONS
64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.
目的
本研究旨在比较 64 排对比计算机断层扫描（CT）、有创电影心室造影术（CVG）、二维超声心动图（2D Echo）和三维超声心动图（3D Echo）在左心室（LV）功能评估方面与磁共振成像（MRI）的准确性。
背景
心脏功能是治疗的重要决定因素，也是冠心病患者长期生存的主要预测因素。有多种方法可用于评估功能，但关于这些方法在同一患者中的比较数据有限。
方法
共 36 例患者前瞻性接受 64 排 CT、CVG、2D Echo、3D Echo 和 MRI（作为参考标准）检查。测量整体和局部 LV 壁运动和射血分数（EF）。此外，还进行了观察者间一致性评估。
结果
对于整体 EF，Bland-Altman 分析显示 CT 与 MRI 的一致性明显高于 CVG（±20.2%）和 3D Echo（±21.2%）（p < 0.005，95%置信区间：±14.2%）。与 MRI 相比，仅 CVG（59.5 ± 13.9%，p = 0.03）显著高估 EF。CT 显示与 2D Echo、3D Echo 和 CVG 相比，对于每搏量的一致性更好。与 MRI 相比，CVG 而不是 CT 显著高估了舒张末期容积（p < 0.001），而 2D Echo 和 3D Echo 则显著低估了 EDV（p < 0.05）。当与 MRI 比较时，4 种方法在评估局部 LV 功能方面的诊断准确性（范围：76%至 88%）无显著差异。64 排 CT、MRI、2D Echo 和 3D Echo 的 EF 观察者间一致性具有高组内相关系数（>0.8），而 CVG 的一致性较低（组内相关系数=0.58）。
结论
与 MRI 作为参考标准相比，64 排 CT 在评估整体 LV 功能方面可能比 CVG、2D Echo 和 3D Echo 更准确。
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