LV function in ischemic heart failure - decreased correlation between Echo and CMR

Transcription

1 LV function in ischemic heart failure - decreased correlation between Echo and CMR Poster No.: C-0590 Congress: ECR 2011 Type: Scientific Exhibit Authors: K. Gruszczy#ska, L. Krzych, K. Golba, P. Ulbrych, T. Roleder, J. Biernat, M. Deja, S. Wo#, J. Baron ; Katowice/PL, Rybnik/ PL Keywords: Cardiac, MR, Echocardiography, Imaging sequences, Ischaemia / Infarction DOI: /ecr2011/C-0590 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 19

2 Purpose To compare cardiac magnetic resonance imaging (CMR) with two-dimensional echocardiography (2D ECHO) in the assessment of left ventricle volumes, mass and EF in patients with ischemic heart disease and severely depressed LV function. Although CMR Is the state- of- the art technique in the assesment of cardiac function, its relationship with echocardiography in patients with severe systolic LV dysfunction is not established yet. Figure1 on page 3 Page 2 of 19

3 Images for this section: Fig. 0: CMR vs. 2D ECHO in the assesment of systolic LV function in patients with ischemic LV failure - The backgroud. Page 3 of 19

4 Methods and Materials Material: 67 patients (12 female) with a multi-vessel coronary artery disease and a history of a myocaridal infarction and low EF were referred for CMR and 2DECHO. The patients' data are summarized in Figure 1 on page 6. The exclusion criteria were arrhythmia and/or contraindications to CMR. Patients with clinically significant aortic valve disease, mitral stenosis and non-ischemic mitral regurgitation were excluded from the analysis. The period of time between CMR and 2DECHO was 5 ± 2 days. CMR protocol CMR studies were performed using a 1,0 T MR Unit (Magnetom Harmony, Siemens) with following parameters: magnetic gradients amplitude: 40mT, slew rate 200mT/m/s, dedicated four-element phase-array receiver coil. Examination protocol consisted of SE/T1 weighted sequence, 'dark blood' images in the axial plane and TruFISP cine ECG gated sequence in 2-chamber, 4-chamber and short axis views. Figure 2 on page 6 Parameters of TruFisp cine sequence are presented in Figure 3 on page 7. The parameters of systolic left ventricle function: EDVi and ESVi, EF and LV mass index (LVMi) were calculated n dedicated workstation (Leonardo, Siemens). Endocardial and epicardial contours were manually drawn on short-axis images by a single operator, unaware of the 2DECHO results. Papillary muscles and endocardial trabeculations were excluded from LV mass. Basal slices with an incomplete muscular ring of less then 75%, were omitted as 'atrial'. 2D ECHO protocol 2DECHO exams were performed using a Sonos 7500 scanner, coupled with a 2.5 MHz sector transducer (Philips Medical System). EDVi, ESVi and EF were obtained by the biplane Simpson's method Figure 4 on page 8. Calculation of the LV mass was performed using the area-length method Figure 5 on page 9. Statistical analysis Page 4 of 19

5 The correlation between the measures in 2DECHO and CMR was evaluated using Pearson's correlation coefficient and the coefficient of determinantion (R2). The relationship between variables was confirmed with a linear regression analysis. The between-method comparison was done with Bland-Altman analysis. Linear regression equation was used to evaluate whether the differences are dependent on the magnitude of measurements. The results of the statistical tests were considered as statistically significant with p<0.05. The statistical analysis was performed by means of MedCalc (MedCalc, Belgium). Page 5 of 19

6 Images for this section: Fig. 0: Demographic features of evaluated patients Page 6 of 19

7 Fig. 0: TruFISP CMR images of LV 2-chamber, 4-Chamber and short-axis projection in a patient with ischemic systolic LV dysfunction. Page 7 of 19

8 Fig. 0: Technical parameters of CMR TruFISP cine sequence. Page 8 of 19

9 Fig. 0: Calculation of LV function in 2D ECHO: Lang RM et al: Eur. J. Echocardiography, 2006:7:79 Page 9 of 19

10 Fig. 0: Calculation of LV mass in 2D ECHO: The area-lenght method Lang RM et al: Eur. J. Echocardiography, 2006:7: Page 10 of 19

11 Results The mean values of LV volumes, EF and mass revealed by CMR and 2D Echo are presented in Figure 1 on page 12. Both methods confirmed the strong decline in systolic LV function in evaluated group of patients (mean EF in CMR: 23.5%; in 2D Echo 28.8%). A moderate to strong correlation between the 2DECHO and CMR measurements in the assesment of LV function was revealed: the highest for EDVi (R2 = 0.73) and ESVi (R2 = 0.69) Figure 2 on page 12, and the lowest for EF (R2 = 0.21) and LVMi (R2 = 0.20) Figure 3 on page 13. The Bland-Altman analysis revealed that both LV volumes were statistically significantly underestimated in the 2DECHO, as compared to the CMR. The mean difference between the CMR and 2DECHO was: for EDVi ml/m2 (95% CI), and for ESVi ml/m2 (95% CI) Figure 4. on page 14 The mean difference between EF measured by CMR and 2DECHO was -5.7% (95% CI). Figure 5 on page 15. For the total range of values, LVMi was significantly overstimated in the 2DECHO, as compared to the CMR. The mean difference between methods was g/m2 (95% CI). Figure 6 on page 16. There were noticable proportional errors; in relation to EDVi, ESVi and LVMi the highest between-method differences were found for the highest measurements and in relation to EF for the lowest values. The results revealed that the agreement between the 2DECHO and CMR were highly dependent on the magnitude of the measurements and that stronger decline in LV function results in higher differences between methods. Page 11 of 19

12 Images for this section: Fig. 0: The mean values of LV function parameters in CMR and 2D ECHO Page 12 of 19

13 Fig. 0: Correlation between the CMR vs 2D ECHO in the assesment of EDVi and ESVi: linear regression analysis. Page 13 of 19

14 Fig. 0: Correlation between the CMR vs 2D ECHO in the assesment of EF and LV Mass index: the linear regression analysis. Page 14 of 19

15 Fig. 0: The between method agreement for EDVi and ESVi: Bland-Altman plot with regression analysis. Page 15 of 19

16 Fig. 0: Correlation between the CMR vs 2D ECHO in the assesment of EF: Bland-Alman plot with regression analysis. Fig. 0: Correlation between the CMR vs 2D ECHO in the assesment of LV mass index: Bland-Altman plot with regression analysis. Page 16 of 19

17 Conclusion In evaluated population of patients with severe ischemic systolic LV dysfunction moderate to strong correlation between CMR and 2DECHO in the assessment of LV function parameters and mass was revealed. The between-method agreement strongly depends on the degree of LV dysfunction. Differences in LV indices are higher in patients with a more severe LV dysfunction. Page 17 of 19

18 References Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7: Gardner BI, Bingham SE, Allen MR, Blatter DD, Anderson JL. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment of cardiac volumes and regional function after myocardial infarction: an intrasubject comparison using simultaneous intrasubject recordings. Cardiovasc Ultrasound 2009;7:38 Pennell DJ, Sechtem UP, Higgins CB, et al. Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report. J Cardiovasc Magn Reson 2004;6: Darasz KH, Underwood SR, Bayliss J, et al. Measurement of left ventricular volume after anterior myocardial infarction: comparison of magnetic resonance imaging, echocardiography, and radionuclide ventriculography. Int J Cardiovasc Imaging 2002;18: Soliman OI, Kirschbaum SW, van Dalen BM, et al. Accuracy and reproducibility of quantitation of left ventricular function by real-time threedimensional echocardiography versus cardiac magnetic resonance. Am J Cardiol 2008;102: Sugeng L, Mor-Avi V, Weinert L, et al. Quantitative assessment of left ventricular size and function: side-by-side comparison of real-time threedimensional echocardiography and computed tomography with magnetic resonance reference. Circulation 2006;114: Mor-Avi V, Jenkins C, Kuhl HP, et al. Real-time 3-dimensional echocardiographic quantification of left ventricular volumes: multicenter study for validation with magnetic resonance imaging and investigation of sources of error. JACC Cardiovasc Imaging 2008;1: Page 18 of 19

19 Personal Information Katarzyna Gruszczynska MD; Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland L.Krzych: 1st Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland K.S. Golba: MD, PHD: Department of Cardiology, Medical University of Silesia, Katowice, Poland P.Ulbrych: Department of Diagnostic Imaging, County Specialist Hospital No. 3, Rybnik, Poland T. Roleder MD: Department of Cardiology, Medical University of Silesia, Katowice, Poland J.Biernat MD: Department of Cardiology, Medical University of Silesia, Katowice, Poland M.Deja MD, PHD: 2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland S. Wos MD. PH.D. Prof: 2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland Jan Baron, MD, PHD: Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland Page 19 of 19