Reflected High-intensity Motion Signals: Can This Ultrasound Phenomenon Be Used for Assessment of Left Ventricular Function?
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Notice bibliographique
Résumé
AIM: In this pioneer study, we aimed to evaluate the diagnostic role of reflected high-intensity motion signals (RIMS) in the assessment of left ventricular (LV) systolic and diastolic function and to analyze the reproducibility of RIMS. RIMS are also known under the name of "spectral Doppler artifacts" and to date have been attributed only to the category of useless noises. METHODS: The value of RIMS in the evaluation of LV function was analyzed in 173 subjects (57 healthy volunteers and 116 patients with chronic coronary and myocardial diseases and arterial hypertension). The level of intra- and inter-observer reproducibility of RIMS was assessed according to the Bland-Altman method in 29 subjects. To record RIMS by conventional pulsed wave Doppler, an apical 4-chamber view was used and the sample volume was placed 3 - 4 cm laterally to the left border of the mitral annulus in projection of the pulmonary tissue. Three components of RIMS are visualized with each cardiac cycle: one systolic (Sa) component and two diastolic (Ea and Aa) components. We have found that RIMS registration did not depend on the quality of LV visualization. In patients with adequate visualization of the cardiac structures and in "difficult" patients with poor LV visualization, RIMS recordings were visually equal. In our study, correlations between LV ejection fraction (EF) and Sa and Aa were found; the cutoff value of Sa < or = 13 cm/s and Aa < or = 15 cm/s separated patients with EF < or = 40 % from other subjects with a sensitivity of 88.2 % and 94.1 % and a specificity of 93.0 % (p <.0001) and 76.9 % (p <.0001), respectively. It was shown that RIMS correlate with the LV diastolic function. The Ea cutoff value of < or = 20 cm/s distinguished subjects with a normal diastolic function from patients with a sensitivity of 88.6 % and a specificity of 80.0 % (p <.0001); the cutoff values of Sa < or = 10 cm/s and Aa < 12 cm/s separated patients with a Grade 4 diastolic dysfunction (according to Canadian consensus recommendations) from other subjects with a sensitivity of 81.8 % and 90.9 %, and a specificity of 98.1 % (p <.0001) and 91.8 % (p <.0001), respectively. The combined evaluation of traditional transmitral E/A ratio and RIMS components allow differentiating of all standard stages of LV diastolic dysfunction in an easy and effective way. The level of intra- and inter-observer reproducibility of RIMS appeared to be acceptable. CONCLUSIONS: 1. Systolic and late diastolic components of RIMS correlate with LV global systolic function, and all components of RIMS correlate with LV global diastolic function; 2. The reproducibility of RIMS components is at an acceptable level; 3. Combined analysis of transmitral E/A ratio and RIMS components can become a promising approach for easy and effective separation of patients with different grades of diastolic dysfunction.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle