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

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Abstract

Background: Simpson ejection fraction, wall motion score index, atrioventricular (AV) plane displacement and fractional shortening are all established formal echocardiographic methods for the assessment of left ventricular systolic function. Visually estimated (eyeballing) ejection fraction may be considered somewhat more subjective, although shown to correlate well with radionuclide ventriculography. We aimed to explore if echocardiographic eyeballing ejection fraction is comparable to formal methods for the evaluation of left ventricular systolic function. Methods: We assessed 89 consecutive patients after myocardial infarction or before coronary angiography. Eyeballing ejection fraction and wall motion score index were evaluated in the long-axis, short-axis and apical four- and two-chamber views. Simpson ejection fraction and AV plane displacement were assessed in the apical views. Fractional shortening was measured in the parasternal long-axis view. The respective systolic function measurements were in each patient made at different time points by a single investigator, masked to prior results. Results: All formal methods correlated significantly with eyeballing ejection fraction (p<0.001): AV plane displacement, R=0.647; FS, R=0.684; four-chamber Simpson ejection fraction, R=0.857; biplane Simpson ejection fraction, R=0.898; and wall motion score index, R=0.919. Conclusion: Eyeballing ejection fraction correlated closely with all formal methods and the correlation coefficient improved with the reliability of 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 systolic function. Since it is readily and quickly performed, eyeballing ejection fraction could be used for routine echocardiography instead of formal methods.

Introduction

Left ventricular systolic function can be assessed by echocardiography and expressed as ejection fraction, wall motion score index, fractional shortening or atrioventricular (AV) plane displacement. These are all important prognostic measurements in patients with chronic heart failure or myocardial infarction and have shown good correlation with the gold standard method, radionuclide ventriculography [1], [2], [3], [4].

Compared to visual quantification, formal quantitative measurements of left ventricular ejection fraction, such as single- or biplane Simpson ejection fraction, may be considered superior echocardiographic methods for clinical and scientific use, because these methods may appear to be little influenced by subjectivity. But these methods are influenced by subjectivity, since the decision about were to mark the endocardial borders is subjective. Furthermore, besides being time consuming, the endocardial border tracing is sometimes difficult to perform, especially in patients with poor image quality, since it is performed on frozen images [4]. Consequently, the limits of agreement versus radionuclide examination are quite wide for these methods [4], [5], [6], [7]. Wall motion score index might be easier to perform in patients with poor image quality, since the segments are evaluated on moving images, but the method is still more time consuming than visual estimation of global ejection fraction. The wall motion score index method is also subjective.

Compared to formal echocardiographic methods for the evaluation of left ventricular ejection fraction, visual estimation (eyeballing) can be done faster and is often easier to perform, even in patients with poor image quality. 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. Furthermore, it has not been properly evaluated using second harmonic imaging. Therefore, we aimed to compare eyeballing ejection fraction with established, formal echocardiographic methods for the evaluation of left ventricular ejection fraction, using modern equipment with second harmonic imaging.

Section snippets

Materials and methods

The study conforms to the ethical guidelines of the 1975 Declaration of Helsinki.

Results

Mean values of the respective methods for the assessment of left ventricular systolic function were: eyeballing ejection fraction, 51.85±14.90 %; AV plane displacement, 11.07±2.70 mm; fractional shortening, 0.32±0.10; single four-chamber Simpson ejection fraction, 52.54±13.45%; biplane Simpson ejection fraction, 54.31±14.33%; and wall motion score index, 1.625±0.400 units. In simple regression analysis, all formal methods correlated significantly with eyeballing ejection fraction (p<0.001): AV

Discussion

In the present study, eyeballing ejection fraction correlated significantly with all formal quantitative methods for the evaluation of left ventricular systolic function. Both wall motion score index and biplane Simpson ejection fraction have been shown to correlate closely with radionuclide ventriculography, more closely than single four-chamber Simpson ejection fraction, fractional shortening and AV plane displacement [7], [16], [17]. Thus, in the present study, the correlation between

Conclusion

Eyeballing ejection fraction correlated significantly with all formal methods for the evaluation of left ventricular systolic function. The correlation with eyeballing ejection fraction improved with the reliability of and the number of views used by the formal quantitative 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 systolic function. Since it is

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