title: Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography.
abstract: BACKGROUND
  Visual assessment of left ventricular ejection fraction (LVEF) is often used in clinical routine despite general recommendations to use quantitative biplane Simpsons (BPS) measurements. Even thou quantitative methods are well validated and from many reasons preferable, the feasibility of visual assessment (eyeballing) is superior. There is to date only sparse data comparing visual EF assessment in comparison to quantitative methods available. The aim of this study was to compare visual EF assessment by two-dimensional echocardiography (2DE) and triplane echocardiography (TPE) using quantitative real-time three-dimensional echocardiography (RT3DE) as the reference method.
  
  
  METHODS
  Thirty patients were enrolled in the study. Eyeballing EF was assessed using apical 4-and 2 chamber views and TP mode by two experienced readers blinded to all clinical data. The measurements were compared to quantitative RT3DE.
  
  
  RESULTS
  There were an excellent correlation between eyeballing EF by 2D and TP vs 3DE (r = 0.91 and 0.95 respectively) without any significant bias (-0.5 +/- 3.7% and -0.2 +/- 2.9% respectively). Intraobserver variability was 3.8% for eyeballing 2DE, 3.2% for eyeballing TP and 2.3% for quantitative 3D-EF. Interobserver variability was 7.5% for eyeballing 2D and 8.4% for eyeballing TP.
  
  
  CONCLUSIONS
  Visual estimation of LVEF both using 2D and TP by an experienced reader correlates well with quantitative EF determined by RT3DE. There is an apparent trend towards a smaller variability using TP in comparison to 2D, this was however not statistically significant.
authors.affiliation: Department of Cardiology, Karolinska University Hospital Huddinge, Stockholm, Sweden. kambiz.shahgaldi@karolinska.se
authors.forename: Kambiz
authors.initials: K
authors.lastname: Shahgaldi
authors.forename: Petri
authors.initials: P
authors.lastname: Gudmundsson
authors.forename: Aristomenis
authors.initials: A
authors.lastname: Manouras
authors.forename: Lars-Ake
authors.initials: LA
authors.lastname: Brodin
authors.forename: Reidar
authors.initials: R
authors.lastname: Winter
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
references.citation: Lancet. 1986 Feb 8;1(8476):307-10
references.pmid: 2868172
references.citation: Am J Cardiol. 1998 Mar 1;81(5):538-44
references.pmid: 9514446
references.citation: Mayo Clin Proc. 1997 Sep;72(9):860-70
references.pmid: 9294535
references.citation: J Am Coll Cardiol. 2004 Aug 18;44(4):878-86
references.pmid: 15312875
references.citation: Radiology. 1986 Mar;158(3):775-7
references.pmid: 3945753
references.citation: Clin Cardiol. 1995 Dec;18(12):726-9
references.pmid: 8608673
references.citation: Am Heart J. 1989 Dec;118(6):1259-65
references.pmid: 2686380
references.citation: Am J Cardiol. 1986 Nov 1;58(10):872-8
references.pmid: 2430442
references.citation: Int J Card Imaging. 1998 Dec;14(6):413-8
references.pmid: 10453396
references.citation: Circulation. 1983 Jan;67(1):205-15
references.pmid: 6847799
references.citation: Echocardiography. 2003 Jul;20(5):401-10
references.pmid: 12848859
references.citation: Circulation. 1979 Mar;59(3):421-30
references.pmid: 761323
references.citation: Eur J Echocardiogr. 2006 Mar;7(2):79-108
references.pmid: 16458610
references.citation: Clin Cardiol. 1991 Nov;14(11):898-902
references.pmid: 1764826
references.citation: Eur Heart J. 1994 Mar;15(3):303-10
references.pmid: 8013501
references.citation: J Am Coll Cardiol. 2004 Jun 2;43(11):2083-90
references.pmid: 15172417
references.citation: J Am Soc Echocardiogr. 2003 Feb;16(2):101-9
references.pmid: 12574735
references.citation: Int J Cardiol. 2005 May 25;101(2):209-12
references.pmid: 15882665
references.citation: Am Heart J. 1992 Feb;123(2):421-6
references.pmid: 1736580
references.citation: Eur Heart J. 1998 May;19(5):696-710
references.pmid: 9717002