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The potential clinical value of contrast-enhanced echocardiography beyond current recommendations

机译:超声心动图增强造影的潜在临床价值

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Contrast agents are used in resting echocardiography to opacify the left ventricular (LV) cavity and to improve LV endocardial border delineation in patients with suboptimal image quality. If a wider use of contrast-enhanced echocardiography would be adopted instead of the current selective approach, diagnoses such as myocardial ischemia and LV structural abnormalities could potentially be detected earlier. The aim was therefore to retrospectively investigate if contrast-enhanced echocardiography beyond the current recommendations for contrast agent usage affects assessment of wall motion abnormalities, ejection fraction (EF) and detection of LV structural abnormalities. A secondary aim was to evaluate the user dependency during image analysis. Experienced readers (n?=?4) evaluated wall motion score index (WMSI) and measured EF on greyscale and contrast-enhanced images from 192 patients without indications for contrast-enhanced echocardiography. Additionally, screening for LV structural abnormalities was performed. Repeated measurements were performed in 20 patients by the experienced as well as by inexperienced (n?=?2) readers. Contrast analysis resulted in significantly higher WMSI compared to greyscale analysis (p?
机译:造影剂用于静息超声心动图检查,以使左心室(LV)腔不透明,并改善图像质量欠佳的患者的左心内膜边界。如果采用造影剂增强超声心动图代替目前的选择方法,则可能会更早地检测出心肌缺血和左室结构异常等诊断。因此,目的是回顾性调查超声造影剂是否超出当前使用造影剂的建议,否则是否会影响壁运动异常,射血分数(EF)和LV结构异常的检测。第二个目的是评估图像分析过程中的用户依赖性。有经验的读者(n == 4)评估了壁运动评分指数(WMSI),并在来自192例患者的灰度和对比增强图像上测量了EF,而没有迹象表明需要进行对比增强超声心动图检查。另外,进行LV结构异常的筛查。有经验的和没有经验的(n = 2)读者对20例患者进行重复测量。与灰度分析相比,对比度分析导致WMSI显着更高(p 0.003)。在通过灰度分析被分类为健康的83例患者中,有55%的患者通过对比分析被重新分类为运动异常。 EF分类没有显着差异(≥55%,45-54%,30-44%,<30%)。在对比分析中检测到左室结构异常,如小梁增加(n≥21),根尖动脉瘤(n≥4),肥大(n≥1)和血栓(n≥1)。对比分析后,对于WMSI和EF,经验丰富的读者在观察者内部和观察者之间的差异以及经验不足的读者和经验丰富的读者之间的差异都减小了。超声心动图造影剂的使用超出了当前使用造影剂的建议,增加了检测到的壁运动和左室结构异常的数量。此外,对比增强超声心动图可提高WMSI和EF评估的可重复性。

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