Ejection fraction determination without planimetry by two-dimensional echocardiography: A new method

Abstract

A new method for determining ejection fraction by two-dimensional echocardiography was assessed in 60 patients undergoing angiography. In method A, the left ventricular minor axis was measured at the midventricular cavity level in end-systole and end-diastole using the apical four chamber view in the 60 patients. The left ventricular major axis was also measured from the left ventricular apex to the base of the mitral valve at end-systole and end-diastole. The ejection fraction was determined using a modified cylinder-ellipse algorithm. In method B, measurements of the left ventricular minor axis were made in 40 consecutive patients, at the upper, middle and lower thirds of the left ventricular cavity at end-systole and end-diastole of the same cardiac cycle and left ventricular major axis was measured as in method A. With use of the same algorithm, three regional ejection fractions were determined and averaged to yield the total ejection fraction. The two echocardiographic methods were compared with single plane cineangiography in all patients and with gated nuclear scanning in 14 patients. Reproducibility was assessed by interobserver comparison. Correlation was determined in all patients and then separately for those with echocardiographic wall motion abnormalities. The correlation coefficient for all patients was 0.79 (probability [p] less than 0.001) for method A and 0.90 (p less than 0.001) for method B. For patients with wall motion abnormalities, method A had a correlation coefficient of 0.38 (p less than 0.1) and method B showed much higher correlation with r = 0.82 (p less than 0.001). Corresponding values for methods A and B in patients without wall motion abnormality were 0.85 (p less than 0.001) and 0.88 (p less than 0.001), respectively. Unlike a previous study, this method directly measures fractional shortening of left ventricular major axis and ejection fraction values are not arbitrarily modified by type of wall motion abnormality. With this method, accurate measurement of ejection fraction can be made by two-dimensional echocardiography without planimetry. In the absence of echocardiographic wall motion abnormalities, a very simple method A suffices. If wall motion abnormalities are present, the regional ejection fraction method B provides excellent results.

Critical Reappraisal of Bedside Echocardiographic Parameters for Estimation of Left Ventricular Ejection Fraction in Acute Myocardial Infarction

“…LVEF According to the Method ofBaran et al [14]: LVEFB = (EDVb -ESVb)/EDVb. The long axis and three equidistant cross-…”

“…3a). The method of Baran et al [ 14] was preferred to the biplane method of Quinones et al [15], since the former is simpler and more rapid to perform. Care was taken to select four-chamber frames obtained in end diastole and end systole from an apical transducer position that allowed recording of the apical longitudinal view by rotation of the transducer.…”

“…Scatterplots of the relations be tween radionuclide LVEF and three two-dimensional pa rameters, i.e. LVEF by Baran et al [14], LVEF by a truncat ed cone model, and wall motion index, are seen in figure 3.…”

“…LVEF by the method of Baran et al [14] and by a geo metrically more correct truncated cone model showed a better correlation with radionuclide ventriculography than LVEF determined by the method of Teichholz et al [12], yet the inadequacy of these models was illustrated by the fact that negative LVEF values were obtained in 2 patients with apical infarcts (fig. 3).…”

Ejection Fraction Derived by Noninvasive Modalities Versus Left Ventricular Angiographic Determination

“…[1][2][3][4] The noninvasive modalities include echocardiography, radionuclide methods, and magnetic resonance imaging. 5 Echocardiography has been widely used for the evaluation of EF as it is readily available and relatively less expensive than other techniques.…”