Sirds kreisā ventrikuļa mērījumu salīdzinājums ehokardiogrāfijā un magnētiskajā rezonansē
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Kardiovaskulārā magnētiskā rezonanse(CMR) ir augstāk vērtēta metode kreisā kambara struktūras un funkcijas izvērtēšanai, salīdzinot ar divdimensionālo(2D) transtorakālo ehokardiogrāfiju(echo), tomēr ikdienas praksē ehokardiogrāfija tiek izmantota ievērojami biežāk. Tika veikts rertospektīvs viena centra pētījums Latvijas Bērnu klīniskajā universitātes slimnīcā, Rīgā. Pētījuma mērķis bija noskaidrot trīs praksē bieži noteiktu kreisā kambara parametru- izsviedes frakcijas (EF), kreisā kambara masas indeksa (LVMI) un kambaru starpsienas biezuma diastolē (IVSD) mērījumu atšķirības starp abām attēldiagnostikas metodēm, lai spriestu par to klīnisko nozīmību. Tika analizēta arī saistība ar echo operatoru un mērījumu atšķirību starp modalitātēm. Pētījumā 45 pacientiem vecumā līdz 18 gadiem(32 zēniem un 13 meitenēm), ar tādām diagnozēm kā kardiomiopātiju, sirds ritma tarucējumiem, miokardītu, iedzimtām sirdskaitēm, tika veikta 2D echo un CMR, nosakot EF, LVMI un IVSD, ar starplaiku neprāsniedzot 3 mēnešus. Pētījumā netika iekļauti pacienti, kuriem laikā starp abu attēldiagnostikas metožu viekšanu tika veiktas sirds operācijas. Mērot EF ar echo tika pielietota Simpsona divplakņu metode. Mērot LVMI ar echo tika pielietota M-mode metode. CMR EF noteikšanai tika izmantota Simpsona metode. Echo iegūtie rezultāti tika attiecnāti pret CMR mērījumiem. EF tika pārvērtēta 68% gadījumu un novērtēta par zemu 29% gadījumu, vienā gadījumā (2%) tā sakrita ar CMR mērījumu. Starpības mediāna echo un CMR noteiktajai EF bija 5( Q1;Q3 -1 līdz 13)%. EF atsevišķo mērījumu korelācija starp echo un CMR bija vidēji cieša ar intraklases korelācijas koeficientu(ICC) ICC=0,611(95%CI 0,345-0,779; p<0,01). LVMI tika pārvērtēts visos gadījumos (92%), izņemot vienu ar mediānu 21(Q1;Q3 13.75-32.00)g/m2. Vienā gadījumā (8%), kad LVMI tika novērtēts par zemu, tas tika novērtēts par zemu par 61g/m2. LVMI mērījumu atšķirības mediāna starp echo un CMR bija 22,50(Q1;Q3 13,75-32,00)g/m2. Korelācija starp echo un CMR noteiktajiem LVMI atsevišķajiem mērījumiem bija cieša, ICC=0,807(95%CI 0,407-0,943; p<0,01). IVSD tika pārvērtēts 42% gadījumu un novērtēts par zemu 38% gadījumu. Tomēr 19% gadījumu echo un CMR noteiktās IVSD vērtības sakrita.. Echo un CMR IVSD mērījumu atšķirības mediāna bija 0,00( Q1;Q3 -1,25 līdz 1,00)mm. IVSD echo un CMR atsevišķo mērījumu korelācija bija ļoti cieša, ICC=0,915(95% CI 0,816-0,962). EF bija vienīgais mērījums, kura vērtību atšķirība no CMR mērījumiem bija statistiski nozīmīgi atkarīga no echo operatora(p<0,03). IVSD mērījumu atšķirības starp abām modalitātēm bija minimālas un klīniski nenozīmīgas. Lai gan echo LVMI vērtības cieši korelēja ar CMR vērtībām, tās ganrīz vienmēr tika pārvērtētas un vērtējamas kā klīniski nozīmīgas. Echo iegūtās EF vērtības pārsvarā tika pārvērtētas salīdzinot ar CMR, un vērtējamas kā klīniski nozīmīgas.
Cardiovascular magnetic resonance(CMR) is considered a superior method for evaluation of left ventricular structure and function, in comparison to two-dimensional(2D) transthoracic echocardiography(echo), though 2D echo is used far more often in clinical practice. A retrospective one center study was carried out in Children’s Clinical University Hospital, Latvia, Riga. The goal of the study was to determine the differences in three left ventricular parameter- ejection fraction (EF), left ventricular mass index (LVMI) and interventricular septal thickness in diastole (IVSD) measurements between echo and CMR, in order to evaluate their clinical significance. Also the association for echo measurement variability depending on echo operator in relation to CMR measurements was assessed. 45 patients under 18 years of age(32 male and 13 female) diagnosed with cardiomiopathy, heart rhythm disturbances, myocarditis, congenital heart disease had echo and CMR performed no longer than three months apart, evaluating EF, LVMI and IVSD. Patients who had heart surgery performed between the two examinations were excluded from the study. EF was measured by echo using the biplane Simpson’s method. LVMI was measured using M-Mode on echo. EF was measured by CMR using Simpson’s method. All of the results acquired by echo were compared to those obtained by CMR. EF was overestimated in 68% of cases and underestimated 29% of the time. In one case (2%) the EF matched that determined by CMR. The EF measurements differed by a median of 5( Q1;Q3 -1 līdz 13)%. EF single measurement correlation between echo and CMR was moderate with an ICC=0,611(95%CI 0,345-0,779; p<0,01). LVMI was overestimated in all cases (92%), but one, by a median of 21(Q1;Q3 13.75-32.00)g/m2. In one case (8%),where LVMI was underestimated, it was by 61g/m2. The difference between echo and CMR single measurement LVMI values had a median of 22,50(Q1;Q3 13,75-32,00)g/m2. Echo determined LVMI single measurement values correlated strongly with those of CMR; ICC=0,807(95%CI 0,407-0,943; p<0,01). IVSD was overestimated in 42% cases and underestimated in 38% of cases. In 19% cases the echo and CMR determined IVSD values matched. Echo and CMR established IVSD values differed by a median of 0,00( Q1;Q3 -1,25 līdz 1,00)mm. IVSD echo and CMR single measurement correlation was very strong, ICC=0,915(95%CI 0,816-0,962). EF was the only value with a statistically significant dependance on the echo operator(p<0,03). IVSD value discrepancies between modalities were minimal and clinically insignificant. Although LVMI measures correlated strongly between echo and CMR, they were almost always overestimated by a clinically significant amount using echo. EF was moslty overestimated by a clinically significant amount using echo.
Cardiovascular magnetic resonance(CMR) is considered a superior method for evaluation of left ventricular structure and function, in comparison to two-dimensional(2D) transthoracic echocardiography(echo), though 2D echo is used far more often in clinical practice. A retrospective one center study was carried out in Children’s Clinical University Hospital, Latvia, Riga. The goal of the study was to determine the differences in three left ventricular parameter- ejection fraction (EF), left ventricular mass index (LVMI) and interventricular septal thickness in diastole (IVSD) measurements between echo and CMR, in order to evaluate their clinical significance. Also the association for echo measurement variability depending on echo operator in relation to CMR measurements was assessed. 45 patients under 18 years of age(32 male and 13 female) diagnosed with cardiomiopathy, heart rhythm disturbances, myocarditis, congenital heart disease had echo and CMR performed no longer than three months apart, evaluating EF, LVMI and IVSD. Patients who had heart surgery performed between the two examinations were excluded from the study. EF was measured by echo using the biplane Simpson’s method. LVMI was measured using M-Mode on echo. EF was measured by CMR using Simpson’s method. All of the results acquired by echo were compared to those obtained by CMR. EF was overestimated in 68% of cases and underestimated 29% of the time. In one case (2%) the EF matched that determined by CMR. The EF measurements differed by a median of 5( Q1;Q3 -1 līdz 13)%. EF single measurement correlation between echo and CMR was moderate with an ICC=0,611(95%CI 0,345-0,779; p<0,01). LVMI was overestimated in all cases (92%), but one, by a median of 21(Q1;Q3 13.75-32.00)g/m2. In one case (8%),where LVMI was underestimated, it was by 61g/m2. The difference between echo and CMR single measurement LVMI values had a median of 22,50(Q1;Q3 13,75-32,00)g/m2. Echo determined LVMI single measurement values correlated strongly with those of CMR; ICC=0,807(95%CI 0,407-0,943; p<0,01). IVSD was overestimated in 42% cases and underestimated in 38% of cases. In 19% cases the echo and CMR determined IVSD values matched. Echo and CMR established IVSD values differed by a median of 0,00( Q1;Q3 -1,25 līdz 1,00)mm. IVSD echo and CMR single measurement correlation was very strong, ICC=0,915(95%CI 0,816-0,962). EF was the only value with a statistically significant dependance on the echo operator(p<0,03). IVSD value discrepancies between modalities were minimal and clinically insignificant. Although LVMI measures correlated strongly between echo and CMR, they were almost always overestimated by a clinically significant amount using echo. EF was moslty overestimated by a clinically significant amount using echo.
Description
Pediatrija
Pediatrics
Veselības aprūpe
Health Care
Pediatrics
Veselības aprūpe
Health Care
Keywords
ehokardiogrāfija, sirds, kardiovaskulārā magnētiskā rezonanse, mērījums, izsviedes frakcija, kreisā kambara masas indekss, miokarda sieniņas biezums, divdimensionāla, trīsdimensionāla, echocardiography, cardiovascular magnetic resonance, measure, ejection fraction, left ventricular mass index, myocardial wall thickness, two-dimensional, three-dimensional