Contrast Administration Reduces Interobserver Variability in Determination of Left Ventricular Ejection Fraction in Patients With Left Ventricular Dysfunction and Good Baseline Endocardial Border Delineation

Nayyar, Sunil; Magalski, Anthony; Khumri, Taiyeb M.; Idupulapati, Madhuri; Stoner, Casey N.; Kusnetzky, Lisa L.; Coggins, Tina R.; Morris, Becky A.; Main, Michael L.

doi:10.1016/j.amjcard.2006.05.038

Cited by 34 publications

(26 citation statements)

References 7 publications

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“…9,19 A study by Lipshultz et al 8 reported an intraclass correlation coefficient of 0.64 for SF by M-mode in 735 pediatric HIV patients where the images were reviewed locally and at a central core laboratory. In our study, the SF (M-mode) %difference was 13.4% when images were reviewed at the local site versus at the core laboratory.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of Left Ventricular Dimension Versus Area Versus Volume Measurements in Pediatric Patients With Dilated Cardiomyopathy

Tierney

Hollenbeck-Pringle

Lee

et al. 2017

Circ: Cardiovascular Imaging

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Background Multiple echocardiographic methods are used to measure left ventricular size and function. Clinical management is based on individual evaluations and longitudinal trends. The Pediatric Heart Network VVV study (Ventricular Volume Variability) in pediatric patients with dilated cardiomyopathy has reported reproducibility of several of these measures, and how disease state and number of beats impact their reproducibility. In this study, we investigated the impact of observer and sonographer variation on reproducibility of dimension, area, and volume methods to determine the best method for both individual and sequential evaluations. Methods and Results In 8 centers, echocardiograms were obtained on 169 patients prospectively. During the same visit, 2 different sonographers acquired the same imaging protocol on each patient. Each acquisition was analyzed by 2 different observers; first observer analyzed the first acquisition twice. Intraobserver, interobserver, interacquisition, and interobserver-acquisition (different observers and different acquisition) reproducibility were assessed on measurements of left ventricular end-diastolic dimension, area, and volume. Left ventricular shortening fraction, ejection fraction, mass, and fractional area change were calculated. Percent difference was calculated as (interobservation difference/mean)×100. Interobserver reproducibility for both acquisitions was better for both volume and dimension measurements (P≤0.002) compared with area measurements, whereas intraobserver, interacquisition (for both observers), and interobserver-acquisition reproducibilities (for both observer-acquisition sets) were best for volume measurements (P≤0.01). Overall, interobserver-acquisition percent differences were significantly higher than interobserver and interacquisition percent differences (P<0.001). Conclusions In pediatric patients with dilated cardiomyopathy, compared with dimension and area methods, left ventricular measurements by volume method have the best reproducibility in settings where assessment is not performed by the same personnel.

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Section: Discussionmentioning

confidence: 99%

Reproducibility of Left Ventricular Dimension Versus Area Versus Volume Measurements in Pediatric Patients With Dilated Cardiomyopathy

Tierney

Hollenbeck-Pringle

Lee

et al. 2017

Circ: Cardiovascular Imaging

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“…14 and Nayyar et al, 19 although Hundley et al 20 noticed improvement in LV-EF variability particularly in subjects with two or more adjacent endocardial segments not seen at baseline.…”

Section: Discussionmentioning

confidence: 99%

“…9 An endocardial visualization score was calculated by adding the score of all 12 segments in every patient. On basis of the quality score two image quality groups were defined: good (score [19][20][21][22][23][24], and moderate-to-poor (score ,19) quality echo.…”

Section: Methodsmentioning

confidence: 99%

Assessment of left ventricular ejection fraction after myocardial infarction using contrast echocardiography

Galema¹,

Geleijnse²,

Yap³

et al. 2007

European Journal of Echocardiography

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Aims Despite its relatively high intra-and inter-observer variability for left ventricular ejection fraction (LV-EF) echocardiography is clinically still the most used modality to assess LV-EF. We studied whether adding a second-generation microbubble contrast agent could decrease this variability. Methods and results Forty-eight patients underwent transthoracic echocardiography in secondharmonic mode (SHI) with and without contrast within 5 days after an acute myocardial infarction. LV-EF was determined using the Simpson's biplane method. With contrast intra-observer variability decreased from 12.5 + 11.5% to 7.0 + 7.0% (P , 0.001) and inter-observer variability decreased from 16.9 + 9.9% to 7.0 + 6.2% (P , 0.001). Bland-Altman analysis confirmed these findings by demonstrating smaller 95% limits of agreement for both the intra-and inter-observer variability when contrast was used. This improvement in intra-and inter-observer variability was seen to a comparable extent in patients with moderate-to-poor and good quality SHI echocardiograms. Conclusion Echo contrast significantly improves intra-and inter-observer variability for LV-EF, both in patients with moderate-to-poor and good quality SHI echocardiograms.

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“…With candidacy for drug and medical device therapy in patients with acute myocardial infarction and heart failure now increasingly determined by physicians with the use of left ventricular (LV) ejection fraction partition values (17,18), accurate and reproducible determination of LV size and systolic function is paramount. Contrast administration improves the agreement of echocardiographically determined LV ejection fraction with reference techniques such as cardiac magnetic resonance and computed tomographic imaging (19 -21), and reduces interobserver variability, even in patients with good baseline endocardial border delineation (22).…”

mentioning

confidence: 99%

Thinking Outside the “Box”—The Ultrasound Contrast Controversy

Main¹,

Goldman²,

Grayburn³

2007

Journal of the American College of Cardiology

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113

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Deposition of local anaesthetic in the proximity of nerves, plexi, within fascial planes, in the paravertebral, epidural or subarachnoid space, is the ever expanding core activity of a regional anaesthetist. Advantages of using ultrasound in this clinical setting include detection of anatomic variants, reduction of volume of local anaesthetic needed with the implication of a lower potential for systemic toxicity, faster onset, real-time assessment of needle advancement avoiding key structures such as blood vessels or pleura, and observation of local anaesthetic spread patterns, all of which are key elements of block success and safety [1]. In addition, we have developed approaches aimed at reducing or quantifying side effects, such as sparing the phrenic nerve when performing an interscalene block [2,3] or assessing the degree of the resulting diaphragm paralysis [4]. From the preoperative to the postoperative period, there appear to be many more opportunities for ultra-sound users to improve patient assessment and management in the ultimate hope of improved perioperative outcomes. Recent guidelines on vascular access recommend the use of ultrasound guidance for all routes of access where the vessel cannot be directly seen or palpated [5]. Routine use of ultrasound had been previously documented for internal jugular central venous catheterisation (unless in emergency or other unusual situations), and early in other procedures (arterial and peripheral venous), if difficult. Clearly, ultrasound makes many steps safer including: evaluation of puncture site, eliminating seeker needles , needle guidance, verification of guidewire/catheters in a vessel, information on central catheter tip position and recognition of complications [5]. As an emerging application, ultrasound has been shown to aid airway evaluation and management with obvious potential benefits for both clinician and patient. Ultrasound can identify vocal cord dysfunction and pathology before induction of anaesthesia thus highlighting potential difficulties. It may be utilized to determine airway size and predict the appropriate diameter of single-and double-lumen endotracheal tubes as well as tracheostomy tubes [6]. It appears to reliably differentiate between tracheal, oesophageal, and bronchial in-tubation. Taken a step forward, ultrasonography of the neck can accurately locate the cricothyroid membrane for emergency airway access and identify tracheal rings for ultrasound-guided tracheostomy. Upper airway point-of-care ultrasound has thus the potential to become the first-line non-invasive adjunct assessment tool in airway management [6]. Much has been published in recent years on the utility of ultrasound for evaluation of gastric content. Inhalation of gastric content during induction, maintenance or emergence from anaesthesia has devastating consequences leading to significant morbidity and mortality. Therefore, evaluation of gastric contents is most helpful in order to inform an assessment of aspiration risk and thus guide anaesthetic management ...

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Contrast Administration Reduces Interobserver Variability in Determination of Left Ventricular Ejection Fraction in Patients With Left Ventricular Dysfunction and Good Baseline Endocardial Border Delineation

Cited by 34 publications

References 7 publications

Reproducibility of Left Ventricular Dimension Versus Area Versus Volume Measurements in Pediatric Patients With Dilated Cardiomyopathy

Reproducibility of Left Ventricular Dimension Versus Area Versus Volume Measurements in Pediatric Patients With Dilated Cardiomyopathy

Assessment of left ventricular ejection fraction after myocardial infarction using contrast echocardiography

Thinking Outside the “Box”—The Ultrasound Contrast Controversy

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