Effect of tissue harmonic imaging and contrast upon between observer and test–retest reproducibility of left ventricular ejection fraction measurement in patients with heart failure

Abstract

Aims: To investigate the effects of tissue harmonic imaging (THI) and contrast chamber opacification (LVO) upon measurement variability and reproducibility of echocardiographic left ventricular (LV) volume and ejection fraction (EF) measurements in patients with heart failure (HF). Background: Echocardiography is often used in HF patients to determine LV volumes and EF. However, current echo methods are variable and may not be applicable for repeat testing in individual patients. THI and LVO have both been shown to improve endocardial visualisation, but it remains to be determined whether this results in better measurement reproducibility. Methods: Thirty-one HF patients and 30 control subjects underwent echocardiography on two separate days. LV volumes were measured under four different imaging conditions: fundamental, THI, LVO and LVO with ECGtriggered Power Doppler. Chamber opacification, pulmonary transit time (PTT), endocardial enhancement, reproducibility and bias were assessed. Results: Chamber opacification was inferior and the PTT longer in the HF patients. PTT was related to LV volumes, EF, jugular venous pressure and mitral filling pattern. THI improved endocardial visualisation, and although LVO improved endocardial visualisation in the controls, it offered no benefit over THI in the HF patients. LV volumes and EF were different for each method and THI was the least variable method for repeat measurements. Conclusions: THI improved endocardial visualisation and was the least variable of the techniques. LVO offered no further advantage in patients with HF and thus cannot be routinely advocated and since LV volumes and EF were different for each, these methods are neither comparable nor interchangeable for follow-up assessments.

How reliable are left ventricular ejection fraction cut offs assessed by echocardiography for clinical decision making in patients with heart failure?

“…By the design of the present study, the LVEF assessment at the recruiting hospital was done either by visual assessment, Simpson's biplane or area length assessment, and thus the 95 % confidence interval of the differences do not represent a strict measurement of interobserver variability. Nevertheless, the variabilities in our study correspond to previously published values of interobserver variability [19,20], while others have published lower values [21][22][23]. An important difference A B C Fig.…”

Reproducibility of Echocardiographic Techniques for Sequential Assessment of Left Ventricular Ejection Fraction and Volumes

“…Specifically, this latter reason likely accounts for the higher variability of Interobserver and Intraobserver Variability and Minimal Detectable Change for EF Measurements by All 6 Techniques Contrast administration has been shown to improve accuracy and observer reproducibility with 2DE in patients with sub-optimal echocardiographic windows (20,21). However, other studies have shown the lack of additional benefit over harmonic imaging with only limited improvement or even worsening in reproducibility of EF measurements in some patient populations (22)(23)(24). The latter might be attributed to blooming and attenuation artifacts that hinder delineation of structures such as the mitral valve, resulting in variability in contouring (23).…”

Myocardial perfusion scintigraphy in asymptomatic diabetic patients: a critical review

“…Therefore, it appears that this modality cannot effectively identify lower risk diabetic patients. It should be added that echocardiographic examinations may often be of suboptimal quality in diabetic patients, many of whom are overweight, this technique suffers from observer agreement and reproducibility and the experience has not been always satisfactory [70,93].…”