Left ventricular ejection fraction and volumes: it depends on the imaging method.
Bottom Line: Only minor differences in LVEF were found in studies comparing CMR and 2D contrast echocardiography or noncontrast 3D echocardiography.However, EDV and ESV measured with all echocardiographic methods were smaller and showed greater variability than those derived from CMR.The agreement of volumes is worse.
Affiliation: Division of Cardiology, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.Show MeSH
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Mentions: Only 2 multicenter studies have been performed to compare CMR with echocardiographic imaging modalities (marked by a † in Figs.1–3). Hoffman et al. investigated 120 patients with variable levels of LV function, of which 55 patients had CMR as well as standard and contrast two-dimensional echocardiography (2D ECHO). They showed in BA analysis for unenhanced 2D ECHO (Simpson's biplane) LVEF to have a good agreement (bias = 0.8%; LOA = −20.0% to 21.6%) with CMR. Contrast-enhanced 2D ECHO (Simpson's biplane) showed a similar agreement (bias = 4.6%; LOAs of −12.4% to 21.6%). End-diastolic volume (EDV) and end-systolic volume (ESV) in unenhanced 2D ECHO showed a bias of −72.3 mL (LOA = −150.3 to 5.7 mL) and −35.7 mL (LOA = −99.4 to 28 mL), respectively, compared with −42.3 mL (LOA = −114.6 to 30 mL) and −27.2 mL (LOA = −80.9 to 26.5 mL) using contrast 2D ECHO. Various combinations of 3 readers (1 onsite and 2 offsite) produced mean percentage errors (MPE) and confidence intervals (95% CI) for 2D ECHO (12.8, 10.9–14.8; 11.7, 10.1–13.4; 12.6, 10.4–14.8) and for contrast 2D ECHO (8.9, 7.5–10.3; 8.8, 7.5–10.2; 4.1, 3.1–5.0). These showed a clear improved agreement when contrast echocardiographic agents were used.16 The second multicenter study, consisting of 92 patients with various degrees of LV function as assessed by Simpson's biplane LVEF assessment, was carried out by Mor-Avi et al. investigating the accuracy and reproducibility of three-dimensional echocardiography (3D ECHO) (5 beat volume acquisition; QLAB, Philips Ultrasound Ltd., Bothell, Washington, USA). The bias (LOAs) were −3% (LOA = ±22%), −67 mL (LOA = ±90 mL), and −41 mL (LOA = ±90 mL) for LVEF, EDV, and ESV, respectively. The degree of bias in the volume calculations was attributed to the less experienced centers in 3D ECHO utilization, which highlights the importance of adequate training in the utilization of 3D ECHO for LV function assessment.17
Affiliation: Division of Cardiology, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.