Reproducibility of determination of right ventricular ejection fraction by radionuclide imaging: Assessment by the statistical method of variance components

Abstract

Confidence limits for single and repeat measurements of right ventricular ejection fraction (RVEF) were established by means of a model based on the statistical method of variance components. A total of 80 subjects (age 23 to 74 years) were examined by two radionuclide methods 1) gated first-pass (fp) technique performed in a standard 30 degrees right anterior oblique projection, and 2) multigated equilibrium imaging (muga) in an individual left anterior oblique view, applying with both methods separate end-diastolic and end-systolic ventricular regions of interest. Values obtained by fp technique were clearly higher than those measured by the muga approach, and the correlation between them was only fair: RVEFmuga = 0.48 RVEFfp + 0.13; r = 0.73; SEE = 0.08. The 95% confidence limits for a single measurement were with the fp technique: 'true' RVEF = measured RVEF +/- 6 EF-units compared to +/- 16 units with the muga method. At repeat determination within an interval of four weeks, the minimal changes in measured RVEF that were statistically significant at the 5% level were with the fp technique +/- 8 units with the same observer on both occasions and +/- 9 units with different observers. Corresponding figures with the muga method were +/- 16 and +/- 22 units, respectively. The minimal changes in a subject's 'true' RVEF necessary to produce a significant change in measured RVEF were with fp technique +/- 14 units for the same observer and +/- 17 units for different observers, compared to +/- 30 and +/- 41 units with the muga method. In conclusion, the variability with the muga approach was far greater than with the fp technique and the consequent reproducibility so poor as to preclude meaningful measurement of RVEF by the muga method.

Right‐sided cardiac function in healthy volunteers measured by first‐pass radionuclide ventriculography and gated blood‐pool SPECT: comparison with cine MRI

“…Accordingly, it is difficult to evaluate changes in RVEF over time if measured by different methods at different time points. We and others (Hoilund-Carlsen et al, 1987;Pattynama et al, 1995) found that the LoA between repeated RVEF measurements with the same technique were lower both for FP and MRI. When measured by GBPS technique, the lower normal value of RVEF was even lower namely 0AE40.…”

“…Accordingly, it is difficult to evaluate changes in RVEF over time if measured by different methods at different time points. We and others (Hoilund‐Carlsen et al. , 1987; Pattynama et al.…”

First-pass radionuclide cardiographic determination of right ventricular ejection fraction and pulmonary transit time: Reliability with and without background subtraction

“…A RAO projection offers the best separation of right atrium and ventricle as the tricuspid valve plane can be identiffed in both right ventricular end-diastole and endsystole. ECG-gating improves reliability of the method [2,3,14] and it has been shown that a double ROI firstpass technique (separate right ventricular ED and ES ROIs) has higher accuracy [3] and precision [4,15] in determining RVEF than a single ED ROI technique or an equilibrium ECG-gated method. Rezai et al [3] showed that the tricuspid valve moves from 9 to 33% of the right ventricular long axis from ED to ES which explains the necessity of the double ROI method.…”

“…H¢ilund-Carlsen et al [15] have performed an interobserver, intraobserver, and interrecording variability study of first-pass measurement of RVEF with a method comparable to our method I (with no background subtraction). Their results were comparable to the present ones regarding inter-and intraobserver variability, but in their interrecording analysis, the second recording was separated from the first one by 1-4 weeks [15]. Our method for determining mPTT had a high precision in the inter-and intraobserver context but there was a systematic difference in the interrecording study as mPTT of R2 was higher than during R1.…”

Serial Changes in Atrial Natriuretic Peptide and Endothelin-1 Concentrations

“…Right-ventricular ejection fraction was determined by a first-pass technique in a standard 30° right anterior oblique projection applying separate end-diastolic and end-systolic regions of interest [8]. The 95% confidence limits of left ventricular ejection fraction (LVEF) based on a single measurement equalled the measured value B 0.06 [9]. Leftventricular variables were determined by multigated equilibrium imaging using an individually adjusted left anterior oblique view for optimal septal separation.…”