Subjective visual echocardiographic estimate of left ventricular ejection fraction as an alternative to conventional echocardiographic methods: Comparison with contrast angiography

Abstract

Summary: Left ventricular ejection fraction (LVEF) is a measure of ventricular function with clinical and prognostic significance and can be reliably calculated with various M-mode and two-dimensional echocardiographic formulas in selected, good quality echocardiograms. Subjective visual echocardiographic estimate of LVEF is a potentially less time consuming and more widely applicable method. In order to test its reliability, we performed a prospective blind trial in 40 consecutive patients undergoing biplane contrast ventriculography (BCV), to compare the visual estimate of LVEF during a complete echocardiogram of three independent observers with (I) cubed Mmode formula, (2) Teichholz M-mode formula, (3) lengtharea method from the four-chamber view, and (4) Simpson's single plane formula. BCV was the reference method. The best correlation with BCV was obtained by visual estimate [r of the three observers, respectively = 0.75; 0.84; 0.811 and M-mode measurements [r (1) = 0.8; r (2) = 0.81, but the most sophisticated methods provided the poorest estimate [r (3) =0.54; r (4) = 0.491. All correlation coefficients improved when good studies, defined as a definition of the endocardia1 surface of more than 75%, were selected (n = 23), but the differences persisted. One observer systematically estimated higher values than the other two (Friedman's test, p <0.01) and this interobserver variability suggests that each echocardiographer should test himself against BCV in his lab in order to apply the visual estimate method reliably.

Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods

“…This is part of the reason why we wanted to examine this relationship in our laboratory. However, our results are in concordance with those shown by other groups, indicating that eyeballing ejection fraction commonly can be used with a high level of accuracy [7,[9][10][11]. Furthermore it has been shown in a study by Akinboboye et al [18] that eyeballing ejection fraction is a method easy to learn.…”

“…Thus, in the present study, the correlation between eyeballing ejection fraction and the respective formal quantitative method improved with the reliability of and the number of views used by the formal method. This finding is in concordance with prior studies indicating that eyeballing ejection fraction may be the most accurate echocardiographic method for the assessment of left ventricular ejection fraction [7,[9][10][11]. The fact that modern equipment with second harmonic imaging was used did not seem to affect the relation between eyeballing ejection fraction and the other methods [7][8][9][10][11].…”

“…This method has also shown good correlation with the gold standard, radionuclide examination, and formal echocardiographic methods in prior studies [7,8,9,10,11]. However, the value of eyeballing ejection fraction is still questioned by some and may differ between echocardiographic laboratories.…”

“…Even left ventricular ejection fraction based on tracing of the endocardial borders is affected by the visual impression, which is likely the case in everyday clinical practice as well as in scientific studies. However, this probably only increases the precision of these formal measurements, since the eyeballing ventricular ejection fraction repeatedly has been show to correlate more closely with radionuclide ventriculography than any formal echocardiographic measurement of left ventricular ejection fraction [7,[9][10][11].…”

Echocardioscopy in Cardiovascular Stratification of Chronic Kidney Diseases: The Nephrologist is the Protagonist

“…valutazione della funzione ventricolare: la valutazione accurata e tempestiva della funzione sistolica dovrebbe essere parte integrante della gestione medica di tutti i pazienti nefropatici, in particolare di quelli che presentano un'instabilità emodinamica. Questo parametro viene spesso valutato qualitativamente mediante la sola ispezione visiva da parte dell'operatore esperto, ottenendo risultati molto affidabili (15). La sorveglianza della funzione sistolica nel tempo è consigliabile nei pazienti in trattamento dialitico cronico.…”