Background
Multiple imaging modalities are available to assess dysfunctional yet viable myocardium; these include Echocardiography, Single Photon Emission Computed Tomography (SPECT) Imaging, Positron Emission Tomography (PET) and Cardiac Magnetic Resonance Imaging (CMRI). The aim of this study is to evaluate the role of 3T CMRI and Echocardiography in the evaluation of patients with Ischemic Cardiomyopathy for left ventricular function at both regional and global levels including the calculation of ejection fraction and segmental wall motion abnormalities based on the 17-segment model of the American Heart Association (AHA).
Material and Methods
This was a Hospital Based Cross Sectional Observational Study, conducted in Department of Cardiology and Department of Radiology, Advanced Cardiac Institute, PT J N M Medical College and Dr. B R A M Hospital between July 2017 to September 2018 in 24 patients with known Ischemic Cardiomyopathy, assessed by Echocardiography and 3T CMRI for Left Ventricular Functions.
Results
The study showed that the mean LVEF by CMRI was 34.08% and the mean LVEF by Echocardiography was 33.27% with a mean difference of 2.89%, standard deviation of bias was of 0.856 and 95% limits of agreement were 1.212-4.568. A poor to fair level of agreement was noted using Cohen’s Kappa (r) is 0.375, Standard Error (SE) of r is 0.035, P value of < 0.0005. The results showed that CMRI had a sensitivity of 94.7%, specificity of 44.1%, Positive Predictive value (PPV) of 65.5% and Negative Predictive value (NPV) of 88.2%. The Echocardiography had a sensitivity of 80%, specificity of 32.4%, with a PPV of 52.8% and a NPV of 63.2%. CMRI has an Excellent Negative Predictive Value of 88.2% which means that 88.2% of the Vascular Territories without SWMA on CMRI did not have a scar.
Conclusions
CMRI and Echocardiography are comparable for assessing Global Left Ventricular functions. There is only a fair degree of agreement between CMRI and Echocardiography for analysis of segmental wall motion abnormalities. CMRI may be more accurate in ruling out a scarred myocardium as compared to Echocardiography, owing to High Negative Predictive value.
A Fully Automated Echocardiography Software Can Accurately Quantify Left Ventricular Ejection Fraction in Patients with Segmental Wall Motion Abnormalities
