Abstract
Purpose
To compare two methods of analysis of regional wall-motion (RWM) using transesophageal echocardiography (TEE).
Methods
Thirty patients undergoing coronary artery bypass surgery were studied. The transgastric short axis view at the mid-papillary level was recorded before and after cardiopulmonary bypass. All images were reviewed by an anesthesiologist trained in TEE and an echocardiographer. Regional wall motion was graded: 1 normal, 2 hypokinetic, 3 akinetic, and 4 dyskinetic. The left ventricle was evaluated according to the guidelines of the American Society of Echocardiography using 6-segment, and 4-segment models. Agreement between observers (interobservers), and for one observer at two different moments (intraobservers), for grading each segment was defined as RWM abnormality scores within 1 grade. A wall-motion score index (WMSI), which is the sum of individual scores divided by the number of segments visualized, was calculated. A Bland Altman analysis was used to assess interobserver variability.
Results
Agreement between observers occurred in 96% and 94% of the examined segments, using 4- and 6segment models respectively. Intraobserver agreement was 99% and 97% for the 4- and 6-segment models. The mean differences (bias) of the interobserver variability in grading the segments were 0.04 ± 0.79 and 0 ± 0.72 using a 4- or 6-segment model. The mean difference of the interobserver variability in WMSI were -0.05 ± 0.42 and 0.05 ± 0.37 using a 4- or a 6-segment model.
Conclusion
Both methods, using either a 4- or a 6-segment model, result in a high intraobserver and interobserver agreement, and a low interobserver variability.
Résumé
Objectif
Comparer deux méthodes d’analyse de la motilité régionale de la paroi cardiaque (MRP) en utilisant l’échocardiographie transœsophagienne (ETO).
Méthode
Trente patients devant subir un pontage aortocoronarien ont participé à l’étude, L’incidence transgastrique dans son axe court au niveau médian du muscle papillaire a été enregistrée avant et après l’opération. Toutes les images ont été examinées par un anesthésiologiste spécialisé en ETO et un spécialiste en échocardiographie. La motilité régionale de la paroi a été graduée: 1, normale; 2, hypokinétique; 3, akinétique et 4, dyskinétique. Le ventricule gauche a été évalué selon les directives de l’American Society of Echocardiography en utilisant des modèles à 6 et à 4 segments. L’accord entre les observateurs (interobservateur) et entre les moments d’observation pour un même observateur (intraobservateur) quant à la gradation de chaque segment a été défini comme des scores d’anomalie de la MRP pour un niveau. Un indice de cotation de la motilité de la paroi (ICMP), qui représente la somme des scores divisée par le nombre de segments visualisés, a été calculé. Une analyse de Bland Altman a été utilisée pour l’évaluation de la variabilité entre les observateurs.
Résultats
Laccord interobservateur est survenu dans 96 % et 94 % des examens de segments, selon des modèles à 4 et 6 segments respectivement. L’accord intraobservateur a été de 99% et 97% pour les modèles à 4 et 6 segments. Les différences moyennes (biais) de la variabilité entre les observateurs dans la gradation des segments ont été de 0,04 ± 0,79 et de 0 ± 0,72 selon un modèle à 4 ou 6 segments. Les différences moyennes de variabilité entre les observateurs concernant l’ICMP ont été de −0,05 ± 0,42 et de 0,05 ± 0,37 selon un modèle à 4 ou 6 segments.
Conclusion
Les deux méthodes, avec modèle à 4 ou à 6 segments, ont présenté un degré élevé d’accord intraobservateur et interobservateur et une faible variabilité entre les observateurs.
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Couture, P., Denault, A.Y., Carignan, S. et al. Intraoperative detection of segmental wall motion abnormalities with transesophageal echocardiography. Can J Anesth 46, 827–831 (1999). https://doi.org/10.1007/BF03012970
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DOI: https://doi.org/10.1007/BF03012970