5/6 Area Length Method for Left-Ventricular Ejection-Fraction Measurement in Adults with Repaired Tetralogy of Fallot: Comparison with Cardiovascular Magnetic Resonance

Abstract

In patients with repaired tetralogy of Fallot (rTOF), left-ventricular ejection fraction (LVEF) predicts adverse outcomes. Two-dimensional echocardiographic (2DE) methods of measuring LVEF require geometric assumptions and may be limited in this population due to altered ventricular geometry. This study evaluated the performance of the 5/6 area × length (AL) method in this population as well as which factors limit agreement with the results of cardiovascular magnetic resonance (CMR). In 20 patients with rTOF (28.5 ± 14.7 years old) and CMR and 2DE within 3 months, two investigators blinded to CMR measured LVEF from 2DE by the AL method, biplane Simpson's (BiS) method, and visual estimate. Two investigators blinded to 2DE measured LVEF from CMR by Simpson's and AL methods. The AL method on 2DE more closely approximated LVEF by CMR (r = 0.73, p = 0.0003) than BiS method (r = 0.53, p = 0.02). AL method was not limited by geometric assumptions, as AL method on CMR closely approximated Simpson's method on CMR (r = 0.90, p < 0.0001) despite median left-ventricular diastolic eccentricity index of 1.24. AL method on 2DE was primarily limited by short-axis area measurement rather than foreshortening of the ventricle. In conclusion, in adults with rTOF, AL method on 2DE moderately approximates LVEF by CMR, even in the context of altered left-ventricular geometry. Although the AL method may be the most appropriate 2DE method in this population, significant limitations remain for LVEF assessment by 2DE, and strategies to optimize image position and border detection are essential.

Diminished right ventricular function at diagnosis of pulmonary hypertension is associated with mortality in bronchopulmonary dysplasia

“…LV systolic function was measured using ejection fraction (LV-EF), and calculated according the 5/6 area × length method which provides an estimated end-diastolic volume (EDV) and end-systolic volume (ESV). 17,18 LV-EF, LV-EDV, and LV-ESV were also calculated using the modified Simpson’s rule. 16,19 RV systolic function was assessed by RV fractional area change (RV-FAC), 20 and tricuspid annular plane systolic excursion (TAPSE).…”

Cardiac Segmental Strain Analysis in Pediatric Left Ventricular Noncompaction Cardiomyopathy

“…LV ejection fraction (LVEF) was calculated using end-diastolic and end-systolic volumes derived from the 5/6 area  length method. 21 The zone between noncompacted and compacted layers was traced as the endocardium for volume assessment; individual trabeculations and recesses were not included when tracing the endocardium for ejection fraction ( Figure 1B). M-mode echocardiography in the short-axis view was used to calculate LV mass using the Devereux method and indexed to BSA, reported with standard Z scores.…”

Impact of pre-eclampsia on the cardiovascular health of the offspring: a cohort study protocol

“…These will be indexed to body surface area. 11 LV mass will be assessed using the 5/6 X area X length method 12 and z scores will be obtained. Linear measurements of base-to-apex length and basal diameter of left and right ventricles will be determined from an apical four-chamber view at end diastole.…”