Impact of Contrast Echocardiography on Assessment of Ventricular Function and Clinical Diagnosis in Routine Clinical Echocardiography: Korean Multicenter Study

Assessing the repeatability, reliability, and precision of right ventricular outflow tract and mid-pulmonary artery diameters, velocity time integrals, and agreement between site-specific stroke volumes

BACKGROUND

Right ventricular (RV) stroke volume (SV) can be calculated via Doppler echocardiography at multiple sites in the right chambers. However, the agreement between the calculated SVs at these sites is unknown. We aimed to assess the repeatability, reliability, and precision of the distal right ventricular outflow tract diameter (RVOTD), the mid-pulmonary artery diameter (MPAD), the right ventricular outflow tract velocity time integral (VTI), and the mid-pulmonary artery velocity time integral (MPAVTI). Additionally, we evaluated the agreement between RVOTSV and MPASV.

METHODS

Four observers each evaluated approximately 100 patients (n = 406). Basic measurements were made over three cardiac cycles, and the repeatability, reliability, and precision of the measurements were calculated. The agreement between the two methods was presented as intraclass correlation coefficients.

RESULTS

The repeatability coefficient ranges for RVOTD, MPAD, RVOTVTI, and MPAVTI were 2-3 mm, 2-4 mm, 2.1-2.8 cm, and 2.4-4.1 cm, respectively. The minimal detectable change ranges for these variables were 2-4 mm, 2-5 mm, 2.2-3.0 cm, and 2.6-4.3 cm, respectively. The respective precision ranges for RVOTD, MPAD, RVOTVTI, and MPAVTI were 2.7-4.7%, 2.4-5.4%, 5.0-7.4%, and 5.4-9.2%. There were significant correlations and agreements between MPASV and RVOTSV, with the Pearson correlation coefficient ranging from 0.63 to 0.89 (P < 0.001). The intraclass correlation coefficient ranged from 0.56 to 0.89 (P < 0.001), although there was a significant bias of 1.9-11.3 mL (P < 0.001).

CONCLUSIONS

The RVOTD, MPAD, RVOTVTI, and MPAVTI measurements were repeatable, reliable, and precise. The agreement between RVOTSV and MPASV ranged from fair to excellent, although significant bias, along with a wide limit of agreement, was observed. Consequently, these methods cannot be used interchangeably.

Obstetrics and Gynecology Acute Abdomen Clinical Diagnosis and Differential Value of Ultrasonography

Acute abdomen in obstetrics and gynecology is a common disease in clinical emergency, most of the patients have the characteristics of complex condition and rapid progress, and need to be treated through clinical diagnosis. There are many traditional diagnosis methods, but the accuracy is not ideal. Ultrasound is a widely used imaging technique in recent years, which has the characteristics of simple operation and high accuracy, so it is favored by doctors and patients in obstetrics and gynecology. In this study, 200 patients with acute abdomen in obstetrics and gynecology were selected, and the results of pathological examination were taken as the gold standard to evaluate the clinical value of ultrasound examination. As a result, the misdiagnosed ultrasound group was significantly lower after the diagnosis than in the normal group, the difference was significant (P < 0.05). Therefore, the use of ultrasound imaging, the clinical diagnosis of acute abdominal diseases in gynecology and obstetrics achieves a clear diagnostic effect, improves the diagnostic accuracy of patients with acute abdominal disease in the clinical. It is very important for the development of targeted therapeutic programmes.

Routine Use of Contrast on Admission Transthoracic Echocardiography for Heart Failure Reduces the Rate of Repeat Echocardiography during Index Admission

BACKGROUND

The authors retrospectively evaluated the impact of ultrasound enhancing agent (UEA) use in the first transthoracic echocardiographic (TTE) examination, regardless of baseline image quality, on the number of repeat TTEs and length of stay (LOS) during a heart failure (HF) admission.

METHODS

There were 9,115 HF admissions associated with admission TTE examinations over a 4-year period (5,337 men; mean age, 67.6 ± 15.0 years). Patients were grouped into those who received UEAs (contrast group) in the first TTE study and those who did not (noncontrast group). Repeat TTE examinations were classified as justified if performed for concrete clinical indications during hospitalization.

RESULTS

In the 9,115 admissions for HF (5,600 in the contrast group, 3,515 in the noncontrast group), 927 patients underwent repeat TTE studies (505 in the contrast group, 422 in the noncontrast group), which were considered justified in 823 patients. Of the 104 patients who underwent unjustified repeat TTE studies, 80 (76.7%) belonged to the noncontrast group and 24 to the contrast group. Also, UEA use increased from 50.4% in 2014 to 74.3%, and the rate of unjustified repeat studies decreased from 1.3% to 0.9%. The rates of unjustified repeat TTE imaging were 2.3% and 0.4% (in the noncontrast and contrast groups, respectively), and patients in the contrast group were less likely to undergo unjustified repeat examinations (odds ratio, 0.18; 95% CI, 0.12-0.29; P < .0001). The mean LOS was significantly lower in the contrast group (9.5 ± 10.5 vs 11.1 ± 13.7 days). The use of UEA in the first TTE study was also associated with reduced LOS (linear regression, β₁ = -0.47, P = .036), with 20% lower odds for odds of prolonged (>6 days) LOS.

CONCLUSIONS

The routine use of UEA in the first TTE examination for HF irrespective of image quality is associated with reduced unjustified repeat TTE testing and may reduce LOS during an index HF admission.

Timely-Automatic Procedure for Estimating the Endocardial Limits of the Left Ventricle Assessed Echocardiographically in Clinical Practice

In this paper, we propose an analytical rapid method to estimate the endocardial borders of the left ventricular walls on echocardiographic images for prospective clinical integration. The procedure was created as a diagnostic support tool for the clinician and it is based on the use of the anisotropic generalized Hough transform. Its application is guided by a Gabor-like filtering for the approximate delimitation of the region of interest without the need for computing further anatomical characteristics. The algorithm is applying directly a deformable template on the predetermined filtered region and therefore it is responsive and straightforward implementable. For accuracy considerations, we have employed a support vector machine classifier to determine the confidence level of the automated marking. The clinical tests were performed at the Cardiology Clinic of the County Emergency Hospital Timisoara and they improved the physicians perception in more than 50% of the cases. The report is concluded with medical discussions.