Subjective visual echocardiographic estimate of left ventricular ejection fraction as an alternative to conventional echocardiographic methods: comparison with contrast angiography.
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 (1) cubed M-mode formula, (2) Teichholz M-mode formula, (3) length-area 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; 0.81] and M-mode measurements [r (1) = 0.8; r (2) = 0.8], but the most sophisticated methods provided the poorest estimate [r (3) = 0.54; r (4) = 0.49]. All correlation coefficients improved when good studies, defined as a definition of the endocardial 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 less than 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.
Mueller
X
X
Division of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Stauffer
J C
JC
Jaussi
A
A
Goy
J J
JJ
Kappenberger
L
L
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000592:standards; D003936:Diagnosis, Computer-Assisted / Q000592:standards; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D005069:Evaluation Studies as Topic; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015635:Radionuclide Ventriculography / Q000592:standards*; D015203:Reproducibility of Results; D013318:Stroke Volume