Measuring Left Ventricular Ejection Fraction – Techniques and Potential Pitfalls

Foley, Thomas A.; Mankad, Sunil; Anavekar, Nandan S.; Bonnichsen, Crystal R.; Miller, Michael; Morris, Todd; Araoz, Philip A.

doi:10.15420/ecr.2012.8.2.108

Cited by 76 publications

(70 citation statements)

References 28 publications

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“…1,2 ROIs can be drawn manually, semi-automatically or automatically. 1,2,12 Automatic ROIs require minor manipulation from the operator. However, manually drawn ROIs require major manipulation, which can lead to increased possibilities of error that are amplified when different operators with various levels of experience process the same data.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Any significant change in LVEF (decrease of 10%) from baseline is an early indicator of cardiac failure and may precede any symptoms of cardiac disease. [3][4][5][6] Early detection of changes allows for intensified monitoring to prevent further complications, initiation of preventative measures or may implicate changes in cancer treatments or patient management.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Previously, only manual processing modes were used to determine LVEF. 1,11 Technological improvements led to the introduction of automatic and semi-automatic processing modes and the evolution of various processing software. However, these developments also increased the probability of variation in determining the LVEF.…”

Section: Introductionmentioning

confidence: 99%

“…(i) Differences between software packages and applied algorithms to calculate LVEF; 1,2,4,12 (ii) Human detection inaccuracies of the true end systole and end diastole images; 1,13 (iii) Differences in software edge-detection algorithms;…”

Section: Introductionmentioning

confidence: 99%

“…ectopic beats or atrial fibrillation) which lead to artificially reduced counts in frames later in the cardiac cycle (end-diastole); (viii) Different operators with various levels of experience processing the same data set which formed the basis of the current study. [1][2][3]14 The extent of variability in LVEF results in a particular setting should be considered where multiple operators and processing modes are available.…”

Section: Introductionmentioning

confidence: 99%

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A study investigating variability of left ventricular ejection fraction using manual and automatic processing modes in a single setting

2015

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Purpose: A planar multi-gated cardiac blood pool acquisition is a non-invasive technique commonly used to measure left ventricular ejection fraction (LVEF).It is essential that the calculation of LVEF be accurate, repeatable and reproducible for serial monitoring of patients. Different processing modes may be used in calculating the LVEF which require various degrees of manipulation.In addition, different operators with varying levels of experience may process the same data set. It is not known whether the inter-operator variability of LVEF values within a single nuclear medicine department has the potential to affect the calculated LVEF and in turn affect patient management. The aim of the study was to determine variability of LVEF values among operators with different levels of experience using two processing modes.Methods: A descriptive cross-sectional study was carried out in a single setting.Four operators with varying levels of experience analysed 120 left anterior oblique projections using manual and automatic processing modes to calculate the LVEF. Inter-and intra-operator correlation was determined.Results: Manual processing showed moderate to strong agreement (r1=0.653) between operators. Automatic processing indicated almost perfect (r1=0.812) inter-operator correlation. Intra-operator correlation demonstrated a trend of decreasing variability between processing modes with increasing levels of experience. Conclusion:Despite the overall inter-operator agreement, significant intraoperator variability was evident in results from operators with less experience.However, the discrepancies were such that the differences in LVEF would not 3 play a role in patient management. It is recommended that automatic processing be used for determining LVEF to limit inter-operator variability.Additionally operator experience should be considered in the absence of standardised processing protocols when different processing modes are available in a single setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A study investigating variability of left ventricular ejection fraction using manual and automatic processing modes in a single setting

2015

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Biomechanics of Cardiac Function

Voorhees

Han

2015

Comprehensive Physiology

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The heart pumps blood to maintain circulation and ensure the delivery of oxygenated blood to all the organs of the body. Mechanics play a critical role in governing and regulating heart function under both normal and pathological conditions. Biological processes and mechanical stress are coupled together in regulating myocyte function and extracellular matrix structure thus controlling heart function. Here we offer a brief introduction to the biomechanics of left ventricular function and then summarize recent progress in the study of the effects of mechanical stress on ventricular wall remodeling and cardiac function as well as the effects of wall mechanical properties on cardiac function in normal and dysfunctional hearts. Various mechanical models to determine wall stress and cardiac function in normal and diseased hearts with both systolic and diastolic dysfunction are discussed. The results of these studies have enhanced our understanding of the biomechanical mechanism in the development and remodeling of normal and dysfunctional hearts. Biomechanics provide a tool to understand the mechanism of left ventricular remodeling in diastolic and systolic dysfunction and guidance in designing and developing new treatments.

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Utilization of cardiac resynchronization therapy in patients with heart failure in the Northern Region of New Zealand

Looi

Gavin

Sidhu

et al. 2018

Journal of Arrhythmia

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BackgroundCardiac resynchronization therapy (CRT) has been shown to improve morbidity and mortality for heart failure (HF) patients. Little is known about the trends in CRT use and outcomes of these patients in New Zealand.MethodMortality, hospitalization events and complications in HF patients in the Northern Region of New Zealand implanted with CRT devices from Jan‐2007 to June‐2015 were reviewed.ResultsTwo‐hundred patients underwent CRT implantation during the study period. There was a gradual increase in CRT‐D implantation (n = 157) but the number remained static for CRT‐P (n = 43). Patients who received CRT‐P were older (mean age 65.9 ± 14.0 years vs 61.5 ± 10.2 years, P < 0.0007) but had a higher left ventricular ejection fraction (LVEF) (33.7 ± 10.5% vs 24.7 ± 6.1%, P < 0.0001) than those undergoing CRT‐D implant procedures. During a median follow‐up of 4 (2.8) years, 29 (14.5%) patients (14.7% in CRT‐D vs 13.9% in CRT‐P, P = 0.91) had died. HF was the cause of death in 73.9% of the patients. There was no difference in all‐cause mortality between patients with CRT‐D and CRT‐P.ConclusionsDespite the proven benefits of CRT in selected HF patients, there continued to be under‐utilization of these devices in HF patients in the Northern Region. Reasons for under‐utilization of these devices need further exploration. These data should be useful for benchmarking individual patient management and national practice against wider experience in the country.

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Measuring Left Ventricular Ejection Fraction – Techniques and Potential Pitfalls

Cited by 76 publications

References 28 publications

A study investigating variability of left ventricular ejection fraction using manual and automatic processing modes in a single setting

A study investigating variability of left ventricular ejection fraction using manual and automatic processing modes in a single setting

Biomechanics of Cardiac Function

Utilization of cardiac resynchronization therapy in patients with heart failure in the Northern Region of New Zealand

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