Contrast-enhanced echocardiography yielded the highest interobserver agreement (kappa 0.77) and accuracy for detecting regional wall motion abnormalities compared to other imaging modalities.
Observational (n=100)
Blinded
Does contrast-enhanced echocardiography improve the detection and interobserver agreement of left ventricular regional wall motion abnormalities compared to unenhanced echocardiography, cMRI, and cineventriculography?
Contrast-enhanced echocardiography provides superior interobserver agreement and accuracy for detecting regional wall motion abnormalities compared to unenhanced echocardiography, cMRI, and cineventriculography.
OBJECTIVES: To define the use of cineventriculography, cardiac magnetic resonance imaging (cMRI), and unenhanced and contrast-enhanced echocardiography for detection of left ventricular (LV) regional wall motion abnormalities (RWMA). BACKGROUND: Detection of RWMA is integral to the evaluation of LV function. METHODS: In 100 patients, cineventriculography and unenhanced and contrast-enhanced echocardiography were performed. Fifty-six of the patients underwent additional cMRI. RWMA were assessed referring to a 16-segment model for cMRI, unenhanced and contrast echocardiography. Cineventriculography was evaluated on a 7-segment model. Hypokinesia in one or more segments defined presence of RWMA. Interobserver agreement among three readers was determined within each imaging modality. Intermethod agreement between imaging modalities was analyzed. A standard of truth for the presence of RWMA was obtained by an independent expert panel decision (EPD) based on clinical data, electrocardiogram, coronary angiography, and blinded information from the imaging modalities. RESULTS: Sixty-seven patients were found to have an RWMA by EPD. Interobserver agreement expressed as kappa coefficient was 0.41 (range 0.37 to 0.44) for unenhanced echocardiography, 0.43 (range 0.29 to 0.79) for cMRT, 0.56 (range 0.44 to 0.70) for cineventriculography, and 0.77 (range 0.71 to 0.88) for contrast echocardiography. Contrast enhancement compared to unenhanced echocardiography improved agreement of echocardiography related to cMRI (kappa 0.46 vs. 0.29) and related to cineventriculography (kappa 0.59 vs. 0.28). Accuracy to detect EPD-defined RWMA was highest for contrast echocardiography, followed by cMRI, unenhanced echocardiography, and cineventriculography. CONCLUSIONS: Analysis of RWMA is characterized by considerable interobserver variability even using high-quality imaging modalities. Interobserver agreement on RWMA and accuracy to detect panel-defined RWMA is good using contrast echocardiography.
Hoffmann et al. (2005) conducted an observational in Left ventricular regional wall motion abnormalities (n=100). Contrast-enhanced echocardiography vs. Unenhanced echocardiography, cMRI, and cineventriculography was evaluated on Interobserver agreement (kappa coefficient) for detection of regional wall motion abnormalities. Contrast-enhanced echocardiography yielded the highest interobserver agreement (kappa 0.77) and accuracy for detecting regional wall motion abnormalities compared to other imaging modalities.