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Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy

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Abstract

Fast breath-hold cardiovascular magnetic resonance (CMR) shows excellent results for interstudy reproducibility of left ventricular (LV) volumes, ejection fraction, and mass, which are thought to be superior to results of 2-dimensional echocardiography. However, there is no direct comparison of the interstudy reproducibility of both methods in the same subjects. A total of 60 subjects (normal volunteers [n = 20], or patients with heart failure [n = 20] or LV hypertrophy [n = 20]) underwent 2 CMRs and 2 echocardiographic studies for assessment of LV volumes, function, and mass. The interstudy reproducibility coefficient of variability was superior for CMR in all groups for all parameters. Statistical significance was reached for end-systolic volume (4.4% to 9.2% vs 13.7% to 20.3%, p <0.001), ejection fraction (2.4% to 7.3% vs 8.6% to 19.4%, p <0.001), and mass (2.8% to 4.8% vs 11.6% to 15.7% p <0.001), with a trend for end-diastolic volume (2.9% to 4.9% vs 5.5% to 10.5%, p = 0.17). The superior interstudy reproducibility resulted in considerably lower calculated sample sizes (reductions of 55% to 93%) required by CMR compared with echocardiography to show clinically relevant changes in LV dimensions and function. Thus, CMR has excellent interstudy reproducibility in normal, dilated, and hypertrophic hearts, and is superior to 2-dimensional echo- cardiography.

Section snippets

Study population:

We investigated 60 subjects in total, of which 47 were men (mean age 51 ± 18 years). The total study group was divided into 3 subgroups: 20 healthy volunteers with no history of cardiac disease and no risk factors; 20 consecutive patients with documented left ventricular (LV) hypertrophy by previous CMR or echocardiography, and 20 consecutive patients with stable congestive heart failure (New York Heart Association classes I to III) of ischemic or dilated cardiomyopathy origin who had dilated

Results

Table 1 lists the age and gender distribution of all 3 subgroups as well as the measured LV parameters with CMR (average of the 2 measurements).

Comparison of reproducibility of CMR and echocardiography:

Our study confirms the excellent interstudy reproducibility of CMR measurements of LV volumes and mass in a large mixed study group, and, importantly, we have also shown substantially superior interstudy reproducibility of CMR over 2-dimensional echocardiography in the same subjects and in all subgroups. Reproducibility was generally better in normal subjects than in patients with abnormal hearts, and this was the case for CMR and echocardiography. Poorer image quality (e.g., patient’s

Acknowledgements

We would like to thank Professor John Martin Bland, PhD, MSc, DIC, ARCS, FSS, for developing the new method for the statistical comparison of interstudy reproducibility.

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    Dr. Grothues was supported by a grant from the ADUMED Foundation, Zurich, Switzerland; and Dr. Bellenger was supported by an educational grant from SmithKline Beecham, through The National Heart and Lung Institute, Imperial College, London, United Kingdom. This work was also supported by CORDA, London; and the Welcome Trust, London, United Kingdom.

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