Reliability of Visual Assessment of Global and Segmental Left Ventricular Function: A Multicenter Study by the Israeli Echocardiography Research Group

Blondheim, David; Beeri, Rоnen; Feinberg, Micha S.; Vaturi, Mordehay; Shimoni, Sarah; Fehske, Wolfgang; Sagie, Alik; Rosenmann, David; Lysyansky, Peter; Deutsch, Lisa; Leitman, Marina; Kuperstein, Rafael; Hay, Ilan; Gilon, Dan; Friedman, Zvi; Agmon, Yoram; Tsadok, Yossi; Liel‐Cohen, Noah

doi:10.1016/j.echo.2009.12.020

Cited by 59 publications

(38 citation statements)

References 22 publications

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“…Interestingly, MRI showed significant interobserver variability despite high intraclass correlation, which may be related to the large degree of manual interaction and may be overcome with additional consented training, as reported by Beerbaum et al (47). For 2D Echo, our results agree well with the studies of Blondheim et al (48) and Hoffman et al (49), which also showed good reliability (intraclass correlation coefficient ϭ 0.78 and 0.79, respectively, vs. 0.86 for this study) for EF. In contrast, for CVG, Hoffman et al (49) reported higher reliability regarding EF (intraclass correlation coefficient ϭ 0.80 vs. 0.58 for this study).…”

Section: Discussionsupporting

confidence: 93%

Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2- and 3-Dimensional Transthoracic Echocardiography

Greupner

Zimmermann

Grohmann

et al. 2012

Journal of the American College of Cardiology

167

108

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Section: Discussionsupporting

confidence: 93%

Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2- and 3-Dimensional Transthoracic Echocardiography

Greupner

Zimmermann

Grohmann

et al. 2012

Journal of the American College of Cardiology

167

108

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“…Instead, worldwide availability of echocardiography is surely greater. Furthermore, several recent studies have shown the excellent interobserver and intraobserver reproducibility of echocardiographic evaluation on LVEF [15,16]. This has been evaluated as similar to that of cardiac magnetic resonance (CMR), even in patients with TM [17].…”

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confidence: 94%

Long‐term use of deferiprone significantly enhances left‐ventricular ejection function in thalassemia major patients

et al. 2012

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A multicenter randomized open-label long-term sequential deferiprone-deferoxamine (DFP-DFO) versus DFP alone trial (sequential DFP-DFO) performed in patients with thalassemia major (TM) was retrospectively reanalyzed to assess the variation in the left ventricular ejection fraction (LVEF) [1].Serial observations of LVEF over 3 years, in the same patient, were retrospectively assessed in 99 patients with TM during the sequential DFP-DFO multicenter randomized open-label trial [1]. A generalized estimating equation (GEE) model was used to demonstrate changes in mean LVEF over time [2].The regression coefficient of treatment suggested that the DFP-alone group showed a statistically significant increase in mean LVEF over time (coefficient 0.97, 95% CI (0.51; 1.44), P-value <0.0001).These findings suggest that long-term treatment with DFP-alone can significantly enhance LVEF over time. These findings agree with a survival analysis reporting a substantial decline in cardiac deaths during recent years, related to the switching of high-risk patients from DFO to chelation regimens that include the oral chelator DFP [3][4][5].Oral chelation treatment has improved greatly adherence and management of patients with TM [6,7].The improvement of the LVEF after 1-year DFP treatment has been reported [8][9][10][11].However, the effects of DFP on LVEF after long-term treatment have not been fully investigated.This letter reports a retrospective survey performed on patients with TM, previously enrolled in a long-term randomized open-label trial carrying ahead in Italy on the behalf of the Italian Society for the Study of Thalassaemia and Haemoglobinopathies (SoSTE) [1]. Ninety-nine out of 213 patients enrolled in the sequential DFP-DFO trial underwent longterm echocardiographic study of LVEF measured at baseline and every 12 months over three consecutive years (Fig. 1). Among these, 39 and 60 received sequential DFP (75 mg/kg for 4 days/week)-DFO (50 mg/kg for 3 days/week) or DFP-alone (75 mg/kg for 7 days/week) treatment, respectively (Table I).The hematological and clinical findings at enrollment are shown in Table I. No differences were observed at baseline between the two randomized groups. Particularly, the main findings of body iron overloading, expressed as serum ferritin at baseline, liver iron concentration (LIC), baseline LVEF <55%, and total number of blood transfusions were not statistically significantly different (Table I). Moreover, although baseline LVEF appears unlike between the two groups ( Fig. 1), this was not statistically significantly different (P-value 5 0.10, Table I).The DFP-alone group showed statistically significant increase over time in mean LVEF in comparison with sequential DFO-FP treatment (coefficient 0.97, 95% CI (0.51; 1.44), P-value <0.0001).Furthermore, the regression coefficient of treatment suggested that there was a statistically significant difference in mean LVEF between the two treated groups favoring the sequential group (coefficient 2.36, 95% CI (0.02; 4.71), P-value 5 0.047, but this ...

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“…9 This takes considerable skill gained by experience as outlined by American Society of Echocardiography criteria. 10 Advances in echo technology (eg, incorporation of second harmonics) have enhanced endocardial visualization; however, the classification of WM by visual assessment is highly observer-dependent 11 and is probably the only area of echocardiography that remains totally qualitative. Despite efforts to develop automated systems for detection and quantification of WM abnormalities, which would make this evaluation more objective and consistent, none has yet been able to replace the expert reader.…”

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confidence: 99%

A New Tool for Automatic Assessment of Segmental Wall Motion Based on Longitudinal 2D Strain

Liel‐Cohen

Tsadok

Beeri

et al. 2010

Circ: Cardiovascular Imaging

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Background— Identification and quantification of segmental left ventricular wall motion abnormalities on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. We constructed an automatic tool for assessment of wall motion based on longitudinal strain. Methods and Results— Echocardiograms of 105 patients (3 apical views) were blindly analyzed by 12 experienced readers. Visual segmental scores (VSS) and peak systolic longitudinal strain were assigned to each of 18 segments per patient. Ranges of peak systolic longitudinal strain that best fit VSS (by receiver operating characteristic analysis) were used to generate automatic segmental scores (ASS). Comparisons of ASS and VSS were performed on 1952 analyzable segments. There was agreement of wall motion scores between both methods in 89.6% of normal, 39.5% of hypokinetic, and 69.4% of akinetic segments. Correlation between methods was r =0.63 ( P <0.0001). Interobserver and intraobserver reliability using interclass correlation for scoring segmental wall motion into 3 scores by ASS was 0.82 and 0.83 and by VSS 0.70 and 0.69, respectively. Compared with VSS (majority rule), ASS had a sensitivity, specificity, and accuracy of 87%, 85%, and 86%, respectively. ASS and VSS had similar success rates for correct identification of wall motion abnormalities in territories supplied by culprit arteries. VSS had greater specificity and positive predictive values, whereas ASS had higher sensitivity and negative predictive values for identifying the culprit artery. Conclusions— Automatic quantification of wall motion on echocardiograms by this tool performs as well as visual analysis by experienced echocardiographers, with a greater reliability and similar agreement to angiographic findings.

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Reliability of Visual Assessment of Global and Segmental Left Ventricular Function: A Multicenter Study by the Israeli Echocardiography Research Group

Cited by 59 publications

References 22 publications

Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2- and 3-Dimensional Transthoracic Echocardiography

Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2- and 3-Dimensional Transthoracic Echocardiography

Long‐term use of deferiprone significantly enhances left‐ventricular ejection function in thalassemia major patients

A New Tool for Automatic Assessment of Segmental Wall Motion Based on Longitudinal 2D Strain

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