Accuracy of Noninvasive Ejection Fraction Measurement in a Large Community-Based Clinic

Abstract

Objective: Compare the agreement of two dimensional echocardiography (echocardiography) and electrocardiogram (ECG)-gated single photon emission computed tomography (SPECT), with left ventricular contrast angiography (angiography) for the evaluation of left ventricular ejection fraction (LVEF).Design: Retrospective cohort study.Data Source: American College of Cardiology National Cardiovascular Data Registry TM (ACC-NCDR). Participants:Patients from a large, community-based clinic in central Wisconsin. Methods:Consecutive patients (1999)(2000)(2001)(2002) were identified from the ACC-NCDR dataset who underwent angiography and echocardiography or SPECT within 1 month of each other for evaluation of LVEF. Noninvasive LVEF values were compared to those obtained by angiography using the paired t-test.Regression analysis was used to assess the relation between the compared methods. Bland-Altman analyses were performed to assess the agreement between LVEF values obtained by the noninvasive techniques and angiography. Sensitivity and specificity of detecting depressed LVEF were determined for noninvasive techniques. Regression equations were determined for estimating angiographic values from the echocardiographic or SPECT values.Results: Five hundred thirty-four patients underwent 542 angiographic studies: SPECT in all 534 patients, combined SPECT and echocardiographic studies in 201 patients, and combined angiographic and echocardiographic studies in 202 patients. Correlation of angiographic LVEFs with both echocardiographic and SPECT LVEFs was significant (r = 0.70 and r = 0.69, respectively; p<0.0001). Echocardiographic LVEFs were lower than those determined by angiography (49% ± 1.0% versus 54% ± 1.0%; p<0.0001). SPECT LVEFs were also lower than angiographic LVEFs (49% ± 0.6% versus 57% ± 0.6%; p<0.0001). For 201 patients who underwent both SPECT and echocardiography, SPECT LVEFs were lower (47% ± 1.0% for SPECT versus 49% ± 1.0% for echocardiography; p<0.05). Bland-Altman analysis revealed widely varying differences between techniques with broad confidence intervals. Nonetheless, sensitivity and specificity for determining LVEFs of <40% for SPECT and echocardiography were 90% and 86%, and 75% and 89%, respectively. LVEF of ≤35% was correctly assessed by both SPECT and echocardiography. Sensitivity and specificity for SPECT were 82% and 89%, and 81% and 88% for echocardiography. Conclusion:At our institution, LVEFs obtained noninvasively by echocardiography or SPECT are lower than angiographic LVEFs with widely fluctuating differences. Regression equations can be used to correct the noninvasive readings. Although lower, noninvasive techniques appear to accurately assess depressed LVEFs (<40% and <35%).The accuracy of noninvasive techniques for the evaluation of LVEF should be considered when managing and determining prognoses of patients with cardiac conditions. Individual institutions should determine the validity of the noninvasive techniques they use to assess LVEF.

Left ventricular ejection fraction measurements: accuracy and prognostic implications in a large population of patients with known or suspected ischemic heart disease

“…Conversely, a consistent number of patients with known or suspected ischemic heart disease undergo gated SPECT to study myocardial perfusion at rest and after stress. In these patients, the value of LVEF is a kind of byproduct, routinely obtained, whose accuracy has been previously demonstrated [28][29][30][31][32][33][34][35]37]. For these reasons, we chose gated SPECT instead of gated blood pool scintigraphy to evaluate the reliability and prognostic implications of LVEF measurements obtained by nuclear cardiology.…”

“…A close correlation, expressed by clinic [37]. Patient data were registered in the American College of Cardiology Data Registry.…”

Comparison of Left Ventricular Volumes and Ejection Fraction Assessment by Two-Dimensional Echocardiography Compared With Gated Myocardial Spect in Patients With Ischemic Cardiomyopathy

“…LV afterload and preload changes). In a retrospective analysis of data from 201 patients comparing accuracy of LVEF measurement echocardiography slightly but nevertheless statistically significantly overestimated LVEF compared to gated-SPECT of myocardium (49% vs. 47% by gated-SPECT) 9 . Concerning a comparison of accuracy of LVEF measurement using 2D-echocardiography and gated-SPECT of myocardium in a group of patients with systolic LV dysfunction the results of LVEF measurement agreement using abovementioned methods were in our work comparable with the study by Berk where evaluating a group of patients with an average LVEF of 29% a correlation coefficient of r=0.72 was found 10 .…”

Semiología y diagnóstico diferencial de la insuficiencia cardíaca crónica

“…Esto puede ser parcialmente útil. El ecocardiograma tiene excelente sensibilidad y especifi cidad para la detección de ICFE-r [35], pero más del 50% de los casos de insufi ciencia cardiaca son explicados por ICFE-p [13,17] y los criterios diagnósticos de ésta aún no están estandarizados [15,[36][37][38][39].…”