title: Assessment of left ventricular ejection fraction after myocardial infarction using contrast echocardiography.
abstract: OBJECTIVE
  Despite its relatively high intra- and inter-observer variability for left ventricular ejection fraction (LV-EF) echocardiography is clinically still the most used modality to assess LV-EF. We studied whether adding a second-generation microbubble contrast agent could decrease this variability.
  
  
  RESULTS
  Forty-eight patients underwent transthoracic echocardiography in second-harmonic mode (SHI) with and without contrast within 5 days after an acute myocardial infarction. LV-EF was determined using the Simpson's biplane method. With contrast intra-observer variability decreased from 12.5 +/- 11.5% to 7.0 +/- 7.0% (P < 0.001) and inter-observer variability decreased from 16.9 +/- 9.9% to 7.0 +/- 6.2% (P < 0.001). Bland-Altman analysis confirmed these findings by demonstrating smaller 95% limits of agreement for both the intra- and inter-observer variability when contrast was used. This improvement in intra- and inter-observer variability was seen to a comparable extent in patients with moderate-to-poor and good quality SHI echocardiograms.
  
  
  CONCLUSIONS
  Echo contrast significantly improves intra- and inter-observer variability for LV-EF, both in patients with moderate-to-poor and good quality SHI echocardiograms.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. t.w.galema@erasmusmc.nl
authors.forename: Tjebbe W
authors.initials: TW
authors.lastname: Galema
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
authors.forename: Sing-Chien
authors.initials: SC
authors.lastname: Yap
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Wim B
authors.initials: WB
authors.lastname: Vletter
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: Ten Cate
mesh_terms: D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015588:Observer Variation; D010743:Phospholipids; D013318:Stroke Volume; D013459:Sulfur Hexafluoride; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride