Optimal two-dimensional echocardiographic method for left ventricular ejection fraction calculation in patients with and without regional wall motion abnormalities: a comparison with radionuclide angiography

ABSTRACT

Serial evaluation of left ventricular [LV] ejection fraction [EF] is important for the management and follow up of cardiac patients. Our aim was to compare LVEF calculated from three different two-dimensional echocardiographic [2DE] methods with multigated radionuclide angiography [RNA], in patients with normal and abnormal shaped ventricles. Therefore, 25 consecutive patients [18 men] referred for RNA underwent precordal 2DE. LVEF was calculated by, [a] Simpson's rule [2DS] through manual endocardial tracing of LV at apical 4-chamber view, [b] single plane ellipse [SPE] using apical 4-chamber view and [c] biplane ellipse [BPE] using apical 4-chamber and apical 2-chamber views. Patients included 2 groups, [A] 17 patients with LV segmental wall motion abnormalities [SWMA], [B] 8 patents with normal LV wall motion [N]. The mean +/- SD of LVEF was 38.9 +/- 6.8, 38.1 +/- 7.1, 37.2 +/- 8.3 and 38.1 +/- 7.8 for RNA. 2DS, SPE and BPE, respectively. For the 25 patients good correlation and non significant differences between LVEF calculated by 2DS, SPE and BPE and values obtained by RNA were found [r=0,94, r=84 and r=0.89] [p=0.7. P=0.4 and p=0.5] respectively. However, 2DS had closer limits of agreement with RNA [-6.4, +7.1] than between both SPE and BPE and RNA [-9.3, +9.7] and [-8.3, +9.1], respectively. There were closer limits of agreements between 2DS and RNA for LVEF calculation in A and B patients subgroup [[-4.5, +5.1] and [-7.8. +8.3]] than that between SPE and RNA [[-8.1, +10.7] and [-9.1, +11.3]], as well as between BPE and RNA [[-6.2, +7.7] and [-8.1, +9.3]], respectively. In patients subgroups, 2DS had better correlation and closer limits of agreement with RNA than SPE and BPE with RNA for LVEF calculation, particularly evident in patients with SWMA [group A]. Finally, it was concluded that no significant difference existed between 2DS. SPE and BPE with RNA for LVEF calculation. 2DS had better correlation and closer limits of agreement than SPE and BPE with RNA for LVEF calculation particularly evident in patients with SWMA. Therefore the use of 2DS for serial accurate LVEF calculation in cardiac patients is recommended