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Assessment of Mitral Valve Regurgitation at Electron-Beam CT: Comparison with Doppler Echocardiography¹

¹ From the Departments of Radiology (A.L., T.H.W., P.R., K.G.A.H., B.H., C.N.H.E.), Internal Medicine I–Cardiology, Angiology, and Pneumology Section (A.C.B.), and Cardiovascular Surgery (S.D., P.M.D.), Charité Medical School, Humboldt University, Berlin, Germany. Received April 4, 2004; revision requested June 17; revision received August 2; accepted September 23. Address correspondence to A.L., Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White Bldg 270, Boston, MA 02114 (e-mail: alexander.lembcke{at}gmx.de).

View larger version (88K): [in a new window]   Figure 1a. Images in a 68-year-old man after anterior myocardial infarction who was transferred for preoperative evaluation of left ventricular anatomy and function at electron-beam CT prior to anterior aneurysmectomy. (a) Electron-beam CT section along short axis of the heart with manually drawn endocardial contours at end diastole (left) and end systole (right) for determining global left ventricular stroke volume (cine protocol). (b) Electron-beam CT section (top) through the aorta transverse to its axis at the level of the pulmonary bifurcation and corresponding attenuation-time curve (bottom) for calculating antegrade stroke volume (flow protocol).

View larger version (90K): [in a new window]   Figure 1b. Images in a 68-year-old man after anterior myocardial infarction who was transferred for preoperative evaluation of left ventricular anatomy and function at electron-beam CT prior to anterior aneurysmectomy. (a) Electron-beam CT section along short axis of the heart with manually drawn endocardial contours at end diastole (left) and end systole (right) for determining global left ventricular stroke volume (cine protocol). (b) Electron-beam CT section (top) through the aorta transverse to its axis at the level of the pulmonary bifurcation and corresponding attenuation-time curve (bottom) for calculating antegrade stroke volume (flow protocol).

View larger version (22K): [in a new window]   Figure 2a. (a) Scatterplot and (b) box plots for comparing regurgitation fractions measured at electron-beam CT with semiquantitative grades established at Doppler echocardiography. Crossbars in a delineate mean values of regurgitation fraction for each echocardiographic grade. Box plots show the medians, quartiles, ranges, outliers () (outliers are defined as values more than 1.5 box lengths away from the end of the box), and extremums () (extremums are defined as values more than three box lengths away from the end of the box). Horizontal lines in the box plots delineate thresholds of regurgitation fraction that best separate echocardiographic grades. There is a close relationship between the CT regurgitation fractions and Doppler echocardiographic regurgitation grades, with Spearman rank correlation coefficient of rs = 0.82 (P < .05).

View larger version (19K): [in a new window]   Figure 2b. (a) Scatterplot and (b) box plots for comparing regurgitation fractions measured at electron-beam CT with semiquantitative grades established at Doppler echocardiography. Crossbars in a delineate mean values of regurgitation fraction for each echocardiographic grade. Box plots show the medians, quartiles, ranges, outliers () (outliers are defined as values more than 1.5 box lengths away from the end of the box), and extremums () (extremums are defined as values more than three box lengths away from the end of the box). Horizontal lines in the box plots delineate thresholds of regurgitation fraction that best separate echocardiographic grades. There is a close relationship between the CT regurgitation fractions and Doppler echocardiographic regurgitation grades, with Spearman rank correlation coefficient of rs = 0.82 (P < .05).

View larger version (20K): [in a new window]   Figure 3a. ROC plots (ROC curves generated by locally-weighted scatterplot smoothing) for detecting and grading mitral valve insufficiency. (a) Plot of grade 0 versus grades I–IV. The optimal threshold for detecting echocardiographic grades I–IV is regurgitation fraction of 6% (sensitivity, 89%; specificity, 81%; PPV, 92%; NPV, 74%). (b) Plot of grades 0–I versus grades II–IV. The optimal threshold for detecting echocardiographic grades II–IV is regurgitation fraction of 20% (sensitivity, 88%; specificity, 87%; PPV, 82%; NPV, 91%). (c) Plot of grades 0–II versus grades III–IV. The optimal threshold for detecting echocardiographic grade III–IV is regurgitation fraction of 30% (sensitivity, 86%; specificity, 92%; PPV, 76%; NPV, 96%). (d) Plot of grades 0–III versus grade IV. The optimal threshold for detecting echocardiographic grade IV is regurgitation fraction of 44% (sensitivity, 93%; specificity, 91%; PPV, 41%; NPV, 99%).

View larger version (20K): [in a new window]   Figure 3b. ROC plots (ROC curves generated by locally-weighted scatterplot smoothing) for detecting and grading mitral valve insufficiency. (a) Plot of grade 0 versus grades I–IV. The optimal threshold for detecting echocardiographic grades I–IV is regurgitation fraction of 6% (sensitivity, 89%; specificity, 81%; PPV, 92%; NPV, 74%). (b) Plot of grades 0–I versus grades II–IV. The optimal threshold for detecting echocardiographic grades II–IV is regurgitation fraction of 20% (sensitivity, 88%; specificity, 87%; PPV, 82%; NPV, 91%). (c) Plot of grades 0–II versus grades III–IV. The optimal threshold for detecting echocardiographic grade III–IV is regurgitation fraction of 30% (sensitivity, 86%; specificity, 92%; PPV, 76%; NPV, 96%). (d) Plot of grades 0–III versus grade IV. The optimal threshold for detecting echocardiographic grade IV is regurgitation fraction of 44% (sensitivity, 93%; specificity, 91%; PPV, 41%; NPV, 99%).

View larger version (20K): [in a new window]   Figure 3c. ROC plots (ROC curves generated by locally-weighted scatterplot smoothing) for detecting and grading mitral valve insufficiency. (a) Plot of grade 0 versus grades I–IV. The optimal threshold for detecting echocardiographic grades I–IV is regurgitation fraction of 6% (sensitivity, 89%; specificity, 81%; PPV, 92%; NPV, 74%). (b) Plot of grades 0–I versus grades II–IV. The optimal threshold for detecting echocardiographic grades II–IV is regurgitation fraction of 20% (sensitivity, 88%; specificity, 87%; PPV, 82%; NPV, 91%). (c) Plot of grades 0–II versus grades III–IV. The optimal threshold for detecting echocardiographic grade III–IV is regurgitation fraction of 30% (sensitivity, 86%; specificity, 92%; PPV, 76%; NPV, 96%). (d) Plot of grades 0–III versus grade IV. The optimal threshold for detecting echocardiographic grade IV is regurgitation fraction of 44% (sensitivity, 93%; specificity, 91%; PPV, 41%; NPV, 99%).

View larger version (19K): [in a new window]   Figure 3d. ROC plots (ROC curves generated by locally-weighted scatterplot smoothing) for detecting and grading mitral valve insufficiency. (a) Plot of grade 0 versus grades I–IV. The optimal threshold for detecting echocardiographic grades I–IV is regurgitation fraction of 6% (sensitivity, 89%; specificity, 81%; PPV, 92%; NPV, 74%). (b) Plot of grades 0–I versus grades II–IV. The optimal threshold for detecting echocardiographic grades II–IV is regurgitation fraction of 20% (sensitivity, 88%; specificity, 87%; PPV, 82%; NPV, 91%). (c) Plot of grades 0–II versus grades III–IV. The optimal threshold for detecting echocardiographic grade III–IV is regurgitation fraction of 30% (sensitivity, 86%; specificity, 92%; PPV, 76%; NPV, 96%). (d) Plot of grades 0–III versus grade IV. The optimal threshold for detecting echocardiographic grade IV is regurgitation fraction of 44% (sensitivity, 93%; specificity, 91%; PPV, 41%; NPV, 99%).

View larger version (28K): [in a new window]   Figure 4a. (a) Bland-Altman plot for measurements of total stroke volume (SV) of left ventricle compared with forward stroke volume in aorta in 62 patients with intact cardiac valves. Differences are plotted against the mean of the two stroke volume measurements. Dashed line = mean difference, dotted lines = 2 standard deviations. (b) Linear regression analysis for measurements of total stroke volume (SV) of left ventricle compared with forward stroke volume in aorta in 62 patients with intact cardiac valves. Solid line = regression curve, dashed lines = 95% CIs. There is substantial agreement with no systematic error between total and forward stroke volume measured at electron-beam CT (intraclass correlation coefficient, rI = 0.93).

View larger version (28K): [in a new window]   Figure 4b. (a) Bland-Altman plot for measurements of total stroke volume (SV) of left ventricle compared with forward stroke volume in aorta in 62 patients with intact cardiac valves. Differences are plotted against the mean of the two stroke volume measurements. Dashed line = mean difference, dotted lines = 2 standard deviations. (b) Linear regression analysis for measurements of total stroke volume (SV) of left ventricle compared with forward stroke volume in aorta in 62 patients with intact cardiac valves. Solid line = regression curve, dashed lines = 95% CIs. There is substantial agreement with no systematic error between total and forward stroke volume measured at electron-beam CT (intraclass correlation coefficient, rI = 0.93).