title: Comparison of echocardiography using tissue harmonics and contrast harmonics with radionuclide angiography for the assessment of left ventricular function.
abstract: BACKGROUND
  Left ventricular ejection fraction (LVEF) is a significant predictor of morbidity and mortality; however, the optimal noninvasive modality for the quantitative determination of LVEF is not apparent.
  
  
  OBJECTIVE
  We verified the hypothesis that the various echocardiographic methods of assessing LVEF using the Method of Discs with contrast (Optison human albumin microspheres; Amersham Health, Princeton, NJ) and visual assessment of LVEF using tissue harmonics and contrast harmonics compare favorably with radionuclide angiography (RNA).
  
  
  METHODS
  In a prospective analysis, 24 consecutive patients scheduled to undergo RNA had an echocardiogram using tissue harmonics and contrast harmonics on the same day. LVEF was assessed by RNA by an experienced, blinded reader using manual determination of the region of interest. LVEF was calculated using the Method of Discs (Simpson's Rule) by a blinded sonographer. LVEF was visually estimated by two blinded readers using echocardiography with tissue harmonics and contrast harmonics on separate occasions.
  
  
  RESULTS
  By linear regression analysis, LVEF determination by echocardiography with contrast using the Method of Discs correlated well with RNA (r = .835, p < .0005). Using Bland-Altman analysis, the second echocardiogram reader had excellent agreement with RNA, whereas the first reader had a mean difference of 5.25% (CI 1.3-9.2; p = .012) with visual assessment using tissue harmonics and a mean difference of 4.67% (CI 0.4-8.8; p = .031) with visual assessment using contrast harmonics compared with RNA. Thus, a small difference in agreement between RNA and echocardiographic visual estimation was noted that appeared to be primarily reader dependent.
  
  
  CONCLUSIONS
  LVEF determination with echocardiography with contrast using the Method of Discs correlated well with RNA and provided agreement across a range of cardiac functions. Visual echocardiographic assessment of LVEF with both tissue harmonics and contrast harmonics correlated well with RNA, but contrast harmonics did not appear to offer an advantage over tissue harmonics alone.
authors.affiliation: Department of Internal Medicine, Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA. falmeda@aol.com
authors.forename: Francis Q
authors.initials: FQ
authors.lastname: Almeda
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hendel
authors.forename: James E
authors.initials: JE
authors.lastname: Macioch
authors.forename: Joanne
authors.initials: J
authors.lastname: Sandelski
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Parrillo
authors.forename: Peter M
authors.initials: PM
authors.lastname: Meyer
authors.forename: Mahala
authors.initials: M
authors.lastname: Johnson
authors.forename: Maria L
authors.initials: ML
authors.lastname: Daniels
authors.forename: Vanessa U
authors.initials: VU
authors.lastname: Go
authors.forename: Steven B
authors.initials: SB
authors.lastname: Feinstein
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011875:Radionuclide Angiography; D015203:Reproducibility of Results; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*