title: Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography.
abstract: OBJECTIVE
  To assess the agreement of left ventricular ejection fraction (LVEF) determinations from unenhanced echocardiography, contrast-enhanced echocardiography, magnetic resonance imaging (MRI), and cineventriculography as well as the inter-observer agreement for each method.
  
  
  RESULTS
  In 120 patients, with evenly distributed EF-groups (> 55, 35-55, < 35%), cineventriculography, unenhanced echocardiography with second harmonic imaging, and contrast echocardiography at low mechanical index with iv administration of SonoVue were performed. In addition, cardiac MRI at 1.5 T using a steady-state free precession sequence was performed in a subset of 55 patients. On-site, and two blinded off-site assessments were performed for unenhanced and contrast echocardiography, cineventriculography, and MRI according to pre-defined standards. Intra-class correlation coefficients (ICCs) were determined to assess inter-observer reliability between all three readers (i.e. one on-site and two off-site). EF was 56.2 +/- 18.3% by cineventriculography, 54.1 +/- 12.9% by MRI, 50.9 +/- 15.3% by unenhanced echocardiography, and 54.6 +/- 16.8% by contrast echocardiography. Correlation on EF between cineventriculography and echocardiography increased from 0.72 with unenhanced echocardiography to 0.83 with contrast echocardiography (P < 0.05). Similarly, correlation on EF between MRI and echocardiography increased from 0.60 with unenhanced echocardiography to 0.77 with contrast echocardiography (P < 0.05). The inter-observer reliability ICC was 0.91 (95% CI 0.88-0.94) in contrast echocardiography, followed by cardiac MRI (0.86; 95% CI 0.80-0.92), cineventriculography (0.80; 95% CI 0.74-0.85), and unenhanced echocardiography (0.79; 95% CI 0.74-0.85).
  
  
  CONCLUSIONS
  Unenhanced echocardiography resulted in slight underestimation of EF and only moderate correlation compared with cineventriculography and MRI. Contrast echocardiography resulted in more accurate EF and significantly improved correlation with cineventriculography and MRI. Contrast echocardiography significantly improved inter-observer agreement on EF compared with unenhanced echocardiography. Inter-observer reliability on EF using contrast echocardiography reaches a level comparable to MRI and is better than those obtained by cineventriculography.
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. rhoffmann@ukaachen.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Stephan
authors.initials: S
authors.lastname: von Bardeleben
authors.forename: Folkert
authors.initials: F
authors.lastname: ten Cate
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Kasprzak
authors.forename: Christian
authors.initials: C
authors.lastname: Firschke
authors.forename: Stephane
authors.initials: S
authors.lastname: Lafitte
authors.forename: Nidal
authors.initials: N
authors.lastname: Al-Saadi
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kuntz-Hehner
authors.forename: Marc
authors.initials: M
authors.lastname: Engelhardt
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Vanoverschelde
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D015646:Ventriculography, First-Pass