Faculty Collaboration Database

Left ventricular ejection fraction in patients with normal and distorted left ventricular shape by three-dimensional echocardiographic methods: a comparison with radionuclide angiography. J Am Soc Echocardiogr 1998 Jun;11(6):620-30

Date

07/10/1998

Pubmed ID

9657401

DOI

10.1016/s0894-7317(98)70038-0

Scopus ID

2-s2.0-0031830938 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

BACKGROUND: Serial evaluation of left ventricular (LV) ejection fraction (EF) is important for the management and follow-up of cardiac patients. Our aim was to compare LVEF calculated from two three-dimensional echocardiographic (3DE) methods with multigated radionuclide angiography (RNA), in patients with normal and abnormally shaped ventricles.

METHODS AND RESULTS: Forty-one consecutive patients referred for RNA underwent precordial rotational 3DE acquisition of 90 cut-planes. From the volumetric data set, LVEF was calculated by (a) Simpson's rule (3DS) through manual endocardial tracing of LV short-axis series at 3 mm slice distance and (b) apical biplane modified Simpson's method ( MS) in 29 patients by manual endocardial tracing of the apical four-chamber view and its computer-derived orthogonal view. Patients included three groups: A, 17 patients with LV segmental wall motion abnormalities; B, 13 patients with LV global hypokinesis; and C, 11 patients with normal LV wall motion. For all the 41 patients, there was excellent correlation, close limits of agreement, and nonsignificant difference between 3DS and RNA for LVEF calculation (r = 0.99, [-6.7, +6.9] and p = 0.9), respectively. For the 29 patients, excellent correlation and nonsignificant differences between LVEF calculated by both 3DS and BMS and values obtained by RNA were found (r = 0.99 and 0.97, p = 0.7 and p = 0.5, respectively). In addition, no significant difference existed between values of LVEF obtained from RNA, 3DS, and BMS by the analysis of variance (p = 0.6). The limits of agreement tended to be closer between 3DS and RNA (-6.8, +7.2) than between BMS and RNA (-8.3, +9.7). The intraobserver and inter-observer variability of RNA, 3DS, and BMS for calculating LVEF(%) were (0.8, 1.5), (1.3, 1.8), and (1.6, 2.6), respectively. There were closer limits of agreement between 3DS and RNA for LVEF calculation in A, B, and C patient subgroups [(-3.5, +5), (-8.4, +5.6), and (-7.8, +8.6)] than that between BMS and RNA [(-8.1, +10.7), (-11.9, +9.3), and (-9.1, +11.3)], respectively.

CONCLUSIONS: No significant difference existed between RNA, 3DS, and BMS for LVEF calculation. 3DS has better correlation and closer limits of agreement than BMS with RNA for LVEF calculation, particularly in patients with segmental wall motion abnormalities and global hypokinesis. 3DS has a comparable observer variability with RNA. Therefore the use of 3DS for serial accurate LVEF calculation in cardiac patients is recommended.

Author List

Nosir YF, Salustri A, Kasprzak JD, Breburda CS, Ten Cate FJ, Roelandt JR

Author

Christian Steve Breburda PhD, MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Echocardiography, Three-Dimensional
Female
Gated Blood-Pool Imaging
Heart Ventricles
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Observer Variation
Reproducibility of Results
Stroke Volume
Ventricular Function, Left