ECHOCARDIOGRAPHIC ASSESSMENT OF REGIONAL AND GLOBAL LEFT-VENTRICULAR FUNCTION - WALL-MOTION SCORING IN PARASTERNAL AND APICAL VIEWS VERSUS APICAL VIEWS ALONE

The aim of the study was to examine the value of echocardiographic wal l-motion scoring in apical views as compared to a conventional combina tion of apical and parasternal views. In 50 consecutive patients refer red to coronary arteriography for potential revascularization, echocar diographic digital image loops of the left ventricle (LV) were recorde d in parasternal long- and short-axis views and in apical long-axis, t wo-, and four-chamber views. Eight of 16 standardized LV segments appe ar both in the apical and in the parasternal views (group 1 segments). The remaining eight segments are visualized in the apical views only (group 2). Using a cross-over design, two cardiologists independently performed regional wall-motion scoring based on apical views, respecti vely, based on the combination of parasternal and apical views. Using the conventional approach (parasternal and apical views) 98% of the to tal 800 segments were scored as compared to 95% when using the mere ap ical approach (P < 0.05); 94% of the 800 segments were scored from bot h approaches. The regional wall-motion score was identical in 76% of g roup 1 segments and in 77% of group 2 segments. It diverged, at most, one score in 94% of group I segments and in 91% of group 2 segments (P > 0.05). LV ejection fraction (EF) calculated on the basis of average wall-motion score exclusively assessed from the apex differed little from angiographic EF (mean difference 2.0%, 95% confidence limits +/- 6.6%). 0 Intraobserver variability of wall-motion scores (n = 25 patie nts) was small and almost identical for the two cardiologists. Similar ly, interobserver variability was small and identical for apical views and conventional views. We conclude that there is no substantial loss of information when echocardiographic evaluation of regional and glob al left ventricular function is performed solely from the apical appro ach.