Echocardiographic methods for quantification of left ventricular ejection fraction: are they interchangeable?

Abstract

This study examined the relationships between left ventricular ejection fraction data derived from four commonly used cardiac ultrasound measurement methods (visual estimation, wall motion scoring, biplane Simpson's method and three-dimensional [3D] echocardiography) to assess whether they can be used interchangeably in the assessment of left ventricular systolic function. Two-dimensional (2D) and 3D data obtained from ultrasound studies for 190 patients (109 men, mean age 56 + 20 standard deviation [SD] years [range 20-87] and 81 women, mean age 61 + 18 SD [range 23-96]) with routine cardiac referrals were analysed. Ejection fractions were estimated for each patient offline using standard 2D echocardiography for visual estimation, wall motion scoring and biplane Simpson's methods, while 3D data were analysed using Phillips 3DQ Advanced software. Bland-Altman analysis was performed to test the agreement between the different measurement techniques allowing determination of significance, bias and 95% limits of agreement. Bland-Altman plots were also used to further investigate whether agreement between methods varied with different levels of left ventricular function. Only two method comparisons (visual estimation versus wall motion scoring and biplane Simpson's method versus 3D echocardiography) showed no statistically significant differences (P ¼ 0.09 and 0.99) or bias (-0.7 and 0). However, the 95% limits of agreement were wide ( -11.1% to 9.8% and -14.3% to 14.3%, respectively). Visual estimation, wall motion scoring, biplane Simpson's method and 3D echocardiography should not be used interchangeably for serial assessment of left ventricular ejection fraction.

Do Echocardiographic Parameters Predict Mortality in Patients With End-Stage Renal Disease?

“…The data on subjective visual assessment of LV function were the most complete and were therefore used in the multivariable analysis when considering LV systolic function. Although visual estimation of LV function can be performed on poor-quality images, it requires high levels of sonographer and cardiologist experience to be accurate and reproducible (38). It was not possible to determine the level of sonographer experience in this study.…”

“…All echocardiographic methods of estimation of LV function are subject to error. Although the wall motion scoring method and biplane Simpson's method have subjective components (38), a 2003 review found that the degree of agreement between subjective visual assessment and reference methods was similar to that obtained with Simpson's rule for the calculation of LVEF (39). Another limitation was that cause of death in Australia and New Zealand Dialysis and Transplant Registry is reported by the treating center and is not based on autopsy reports, so there are likely to be errors in the classification of cause of death.…”

“…The last echocardiogram before transplantation or the most recent echocardiogram (for individuals not transplanted) was analyzed as representing the most relevant data available to the transplanting physician. The following echocardiographic variables were examined: LV end-diastolic (38,39). Locally, ''normal'' approximates an LVEF more than 50%, mild impairment LVEF 40% to 50%, moderate impairment 30% to 40%, and severe impairment less than 30%.…”

Effect of Obesity on Left Ventricular Diastolic Function in Children

“…While the subjects were in the left lateral decubitus position, two-dimensional, pulsed-wave Doppler transmitral recordings and tissue Doppler imaging (TDI) recordings of the mitral annulus diastolic velocities were performed with conventional views (parasternal long and short axes, apical 4-chamber) by a cardiologist with a 3.5-MHz sector transducer (Esaote MyLab 50, Genoa, Italy) and with simultaneously ECG recordings according to the recommendations of the American Society of Echocardiography (ASE) proposals (16) . Ejection fraction and left ventricle mass index (LVMI) were determined as described previously (17,18) . We performed pulsed-wave Doppler to measure mitral infl ow velocity in apical 4-chamber view during diastole.…”

Limited pre‐operative echocardiography: are the limitations justified?

“…The authors did not state how left ventricular ejection fraction was assessed nor if the same technique was used by all operators. Four standard methods (Simpson’s biplane, Teicholz, wall‐motion scoring and ‘eyeballing’) are poorly interchangeable [7]. The first two do not correlate well with left ventricular ejection fraction in left ventricular hypertrophy [8] and are affected differently by permanent cardiac pacing [9].…”