Clinical Research
Cardiac Imaging
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: Comparison With Magnetic Resonance Imaging as the Reference Standard

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Objectives

This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI).

Background

Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients.

Methods

A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed.

Results

For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG—but not CT—significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58).

Conclusions

64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.

Key Words

computed tomography
echocardiography
left ventricular function
magnetic resonance imaging

Abbreviations and Acronyms

2D Echo
2-dimensional echocardiography
3D Echo
3-dimensional echocardiography
CT
computed tomography
CVG
cineventriculography
EDV
end-diastolic volume
EF
ejection fraction
ESV
end-systolic volume
LV
left ventricular
MRI
magnetic resonance imaging
SV
stroke volume

Cited by (0)

Dr. Dübel is deceased. Dr. Dewey has received grant support from GE Healthcare Biosciences, Bracco, Guerbet, and Toshiba Medical Systems; has received lecture fees from Toshiba Medical Systems and Bayer (Schering-Berlex); is a principal investigator of multicenter studies on cardiac computed tomography (CORE-64 and CORE-320) sponsored by Toshiba Medical Systems; is the author of Coronary CT Angiography and Cardiac CT, published by Springer, and offers hands-on workshops on cardiac CT (www.ct-kurs.de); is a consultant for Guerbet; is a speaker for Toshiba Medical Systems, Cardiac MR Academy Berlin, Guerbet, and Bayer-Schering; and has relationships with the German Heart Foundation and the European Fund for Regional Development. Dr. Hamm has received grant support from GE Healthcare, Schering, Siemens Medical Solutions, and Toshiba Medical Systems; and has received lecture fees from Siemens Medical Solutions and Schering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.