| Background: Left ventricular noncompaction(LVNC)is a disease of myocardial phenotype caused by genetic mutations or non-genetic factors.The typical characteristic of myocardium is divided into two layers,one is abnormal increase of trabecular forming a non-compacted layer and the other is thin layer of compaction.At present,two-dimensional echocardiography(2DE)is used to diagnose LVNC.The interface reflection at the trabeculae make echo of the compaction layer and the non-compaction layer different,which is beneficial to identify noncompaction layer.However,due to the near-field effect,image quality of apical view is poor,and the image quality is susceptible to the acoustic window,instrument resolution,and operator experience.In order to overcome defects of 2DE,left ventricular opacification(LVO)is Clinically increasingly used to assist in the diagnosis of LVNC.Intertrabecular recesses perfused with contrast agents which produces strong nonlinear echo signal can be detected the location and range clearly.Contrast-enhanced echo through LVO improves the determination of the LV endocardial border,accuracy of the compacted layer measurements and image quality in apical views.However,due to excessively strong harmonic signals generated by the microbubble scattering,it is easy to cover trabeculae,and image quality of the non-compaction is inferior to 2DE.At present,ultrasound has high sensitivity and low specificity in the diagnosis of LVNC.How to apply ultrasound to improve the accuracy of LVNC diagnosis has been a hot topic.Although both 2DE and LVO are common methods of examination for LVNC,few studies have investigated diagnostic value of 2DE and LVO combination for LVNC.Cardiac magnetic resonance imaging(CMR)provide an accurate and reliable evaluation of the localization and extent of non-compacted myocardium with high resolution.Therefore,we focus on the diagnostic advantages of 2DE+LVO for LVNC,with CMR as Diagnostic standard.Aims: To compare different methods of echocardiography with CMR in diagnostic accuracy,segmental analysis and cardiac function of patients with suspected LVNC.Materials and Methods: 30 patients(19male,mean age 37.87±16.9)with suspected LVNC diagnosed through 2DE were recruited on echocardiographic criteria prospectively.Ultrasound images including 2DE and LVO of LVNC are collected,analyzed by QLAB.Observing whether the myocardium was stratified and selecting the most typical segment of the two-layered structures to measure the NC/C ratio at the end of systole for subsequent analysis.A total of 15 cases were randomly selected.One week later,NCRs were calculated through 2DE,LVO and 2DE+LVO by same reader for Intra-observer analysis and independently analyzed by another experienced echo-cardiologist for inter-observer reproducibility.CMR studies were performed during the same week.Each patient were scanned by 1.5 T MR system using a phased array heart coil.The CINE image sequences were acquired.The images were analyzed by syngo.via workstation.According to AHA/ACC 16-segment model,comparing echocardiography at end-systolic with CMR at end-diastole in analyzed segments,non-compacted segments,NC/C values,size of left ventricular chamber,and cardiac function.Result:,the detection rates of positive cases of 30 patients by 2DE,2DE+LVO were 60% and 63%,respectively.No significant statistical difference was observed(P=0.55).CMR can identify all 480 segments,whereas 421,425 and 471 segments could be analyzed by 2DE,LVO,2DE+LVO.The detection rate is about 88%,95%,98% respectively(P<0.001).In the analytical segments,CMR detected 82 NC segments significantly higher than the 2DE,LVO and 2DE+LVO which detected 28(34%),24(29%),36(44%)segments respectively(P<0.001).The NC/C value measured by 2DE+LVO was higher than that of 2DE and LVO,but still lower than the NC/C value of CMR(P<0.001).Compared with 2DE and LVO,NCRs measured by 2DE+LVO had better Intra-and inter-observer reproducibility,which improves the detection rate of positive cases.The LV cavity size assessed with LVO which was closer to the CMR result was larger than with 2DE(P < 0.05).No significant difference between 2DE,LVO and CMR in LVEF(P=0.187).Conclusion: Compared with 2DE,LVO,2DE+LVO improves the determination of the LV endocardial border which increases the display rate of LVNC segments and improve sensitivity and specificity of positive segment detection,measurement accuracy,repeatability.Background: Diagnosis of LVNC mainly relies on morphological changes by echocardiography.Among the three major diagnostic criteria,Chin et al.recommend calculating the distance from the epicardial surface to the trough of the trabecular recess relative to the distance from the epicardial surface to the peak of the trabeculations at end-diastole.Jenni et al.recommend measuring the thickness of compacted layer and non-compacted layer at the end of systole.The criteria proposed by St?llberger et al.is not indicated the phase of observation.Currently,criteria proposed by Jenni are widely used.It is recommended that ratio of noncompacted to compacted myocardium(NCR)was > 2 at short-axis is characteristic at end-systole.However,because of trabecular contraction at end-systole,inter-trabecular recesses are invisible,which is difficult to measurement and diagnosis.Clinically,it is accustomed to observe myocardial structure at end-diastole and evaluate the ratio of compacted layer to noncompacted layer.In addition,diagnosis of LVNC by CMR is also observed at end-diastole.At present,there are few studies about diagnostic value of LVNC in different phases with Echocardiography.Therefore,on the basis of the first part,we focus on the diagnostic value of 2DE+LVO in different diagnostic phases for LVNC.Aims: With CMR as gold standard,Comparative analysis of the diagnostic value of diagnosis of LVNC by 2DE+LVO at end-diastole and 2DE+LVO at end-systole.Materials and Methods: 30 patients(19male,mean age 37.87±16.9)with suspected LVNC diagnosed through 2DE were recruited on echocardiographic criteria prospectively.Ultrasound images including 2DE and LVO of LVNC are collected,analyzed by QLAB.Selecting the most typical segment of the two-layered structures to measure the NC/C ratio at end-systole and at end-diastole for subsequent analysis.A total of 15 cases were randomly selected from 30 patients suspected with LVNC.One week later,NCRs were calculated by same reader for Intra-observer analysis and independently analyzed by another experienced echo-cardiologist for inter-observer reproducibility.According to AHA/ACC 16-segment model,comparing echocardiography at different phases with CMR at end-diastole in segments of two-layered structures,non-compacted segments and NC/C values,diagnostic result of cases.Result: Although there was no statistically difference in the diagnosis of 2DE+LVO at end-diastole,2DE+LVO at end-systole,and CMR(P=0.115),the detection rate of positive cases at end-diastole(80%)was higher than that at end-systole(70%).The diagnostic sensitivity and negative predictive value have been improved at end-diastole.Thirty patients included 480 segments,and two-layered structures were detected located in apical,anterior wall of middle,and lateral wall of middle.There were 240,213,and 170 two-layered segments detected by CMR,2DE+LVO at end-diastole and 2DE+LVO at end-systole,respectively.The difference between the three groups was statistically significant(P<0.001).2DE+LVO at end-diastole obtained more two-layered segments than 2DE+LVO at end-systole and the difference was statistically significant(P=0.01),and there was no difference compared with CMR(P=0.081).There was statistically significant difference between 2DE+LVO at end-systole and CMR of number of two-layered segments(P<0.001).The NC segments were detected located in anterior wall,lateral wall and inferior wall of apical.The number of NC segments obtained by CMR,2DE+LVO at end-diastole,2DE+LVO at end-systole was 82,70,and 36,respectively,and the difference was statistically significant(P<0.001).2DE+LVO at end-diastole obtained more NC segments than 2DE+LVO at end-systole(P=0.001).There was no difference between 2DE+LVO at end-diastole and CMR(P=0.213),but 2DE+LVO at end-systole and CMR results were different(P=0.001).NCRs measured by 2DE+LVO at end-diastole and end-systole have better Intra-and inter-observer reproducibility.2DE+LVO at end-systole was better than end-diastole.But NCRs measured by 2DE+LVO at end-diastole were highly consistent with CMR ICC=0.93 r=0.94.The diagnostic rates of positive cases were different,which obtained through 2DE + LVO at end-diastole(80%)and 2DE+LVO at end-systole(70%),respectively.Conclusion: Analysis by echocardiography at end-diastole significantly increased two-layered segments and positive segments and improved diagnostic accuracy,and correlation of measurement between echocardiography and CMR was higher.Analysis by echocardiography at end-diastole and end-systole have good repeatability and consistency,and measurement results are more stable.at end-systole.Background: Left ventricular two-layered structures occurs not only in LVNC patients,but also in healthy people,athletes,pregnant women,hypertrophic cardiomyopathy,dilated cardiomyopathy and heart with increased left ventricular load due to any causes.Echocardiography is non-invasive,easy to use,real-time,and inexpensive,therefore is still the first choice for LVNC diagnosis.The current echocardiographic criteria for LVNC were mostly retrospectively analyzed.The criteria were derived from a small number of patients,with no multiple groups of controls and poor applicability of diagnostic criteria between different ethnic groups.Currently,the diagnostic cut-off value of ultrasound diagnosis of LVNC of Han population is not very clear.The previous two parts of this study show the diagnostic advantages of 2DE+LVO at end-diastole of LVNC.The third part is based on the previous result,to study diagnostic cut-off value of LVNC with 2DE+LVO at end-diastole of Han population.Aims: To determine cut-off value of NC/C ratio by echocardiography at end-diastole for LVNC diagnosis of Han populationMaterials and Methods: We enrolled 26 diagnosed of LVNC.The remaining subjects were 20 with hypertrophic cardiomyopathy(12male,mean age 52.05±3.09),20 with LV Pathologic remodeling secondary to Pressure / volume load(16male,mean age 48.70±3.09),20 healthy volunteers(12male,mean age 41.15±3.09).Ultrasound images including 2DE and LVO were collected of all cases and analyzed by QLAB.According to AHA/ACC 16-segment model,the most typical segments of two-layered structures were selected to measure the NC/C ratio.Comparing NC/C ratio obtained by 2DE+LVO at end-diastole between groups and determining cut-off value of NC/C ratio of LVNC by ROC curve.Result: The NC/C ratio of the LVNC group was significantly higher than that of other control groups(P<0.001).The NC/C ratio 2.4 obtained by 2DE+LVO at end-diastolic had high diagnostic accuracy for LVNC with values for sensitivity,specificity,positive,and negative predictions of 92% 93% 87% 98%,respectively.NC/C ratio > 2.4 can distinguish pathological non-compaction from other less degree of non-compaction encountered in healthy,dilated and hypertrophied hearts.Conclusion: The end-diastolic ratio of NC/C ratio > 2.4 had high diagnostic accuracy for LVNC in a Chinese adult Han population... |
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