Are ejection fraction measurements by echocardiography and left ventriculography equivalent?
BACKGROUND
Left ventricular ejection fraction (EF) is an important parameter in the diagnosis and treatment of patients with coronary heart disease. Previous studies comparing echocardiography and contrast left ventriculography (CVG) for the measurement of EF have shown considerable variation in results, yet, in clinical practice, EF measurements are used interchangeably. The purpose of this study was to assess the concordance between echocardiography and CVG for the determination of EF in routine clinical practice and to identify factors associated with variation in test results.


METHODS
We reviewed the medical records of 5,385 patients hospitalized for acute myocardial infarction between 1997 and 2005 as part of a community-based surveillance project. Of these, 741 patients had EF measurements recorded by both echocardiography and CVG during hospitalization.


RESULTS
While good correlation (r = 0.73) and no systematic bias were noted between the measurement of EF by echocardiogram compared to CVG, there was wide variation between the 2 methods for any given patient. In approximately one third of patients with acute myocardial infarction, the measurement of EF by echocardiography and CVG differed by >10 points, while in approximately 1 in 20 patients, EF measurements by echocardiography and CVG differed by >20 points. The number of days between tests to measure EF, level of EF, temporal order of EF testing, and patient-related factors made only a minor contribution to the variation in test results.


CONCLUSIONS
Our results demonstrate that, in routine clinical practice, EF determinations obtained by echocardiography and CVG may vary widely, with potentially important clinical implications.
Joffe
Samuel W
SW
Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Ferrara
Jarrod
J
Chalian
Armen
A
Tighe
Dennis A
DA
Aurigemma
Gerard P
GP
Goldberg
Robert J
RJ
D000368:Aged; D000790:Angiocardiography; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
Lancet. 1986 Feb 8;1(8476):307-10
2868172
Circulation. 1979 Oct;60(4):760-6
476879
J Am Coll Cardiol. 2004 Aug 4;44(3):671-719
15358045
Am J Cardiol. 2004 Dec 1;94(11):1373-8
15566906
J Am Coll Cardiol. 1999 Sep;34(3):890-911
10483976
Am Heart J. 2003 Sep;146(3):380-2
12947351
Circulation. 2005 Dec 13;112(24):3738-44
16330684
J Am Soc Echocardiogr. 2006 Dec;19(12):1462-5
17138030
Clin Med Res. 2005 May;3(2):75-82
16012124
Am J Cardiol. 1999 Aug 1;84(3):299-303
10496439
J Am Coll Cardiol. 1999 Jan;33(1):180-5
9935027
Circulation. 1983 Jan;67(1):205-15
6847799
Int J Clin Pract. 2004 Dec;58(12):1120-6
15646409
Circ Cardiovasc Qual Outcomes. 2009 Mar;2(2):88-95
20031820
J Natl Med Assoc. 2007 Nov;99(11):1227-8, 1231-4
18020097
J Am Soc Echocardiogr. 2002 Apr;15(4):293-301
11944005
Am Heart J. 2003 Sep;146(3):388-97
12947354
Am J Cardiol. 2008 Mar 1;101(5):706-11
18308026