Non-Invasive Assessment of Left Ventricle Ejection Fraction: Where Do We Stand?

Abstract

The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently available for the non-invasive assessment of LVEF. The aim of this review is to describe their relative advantages and disadvantages, proposing a hierarchical application of the different imaging tests available for LVEF evaluation based on the level of accuracy/reproducibility clinically required.

Inter‐ and intra‐observer variability in the echocardiographic evaluation of wall motion abnormality in patients with ST‐elevation myocardial infarction or takotsubo syndrome – A novel approach

“…The inter‐ and intra‐observer variability for PrA in our study is similar to that reported for several of the most commonly used echocardiographic parameters in different patient groups 8,10–13 , suggesting that this metric can be reliably used. The nominally smaller inter‐ and intra‐observer variability for PrA compared to WMSI may be related to the fact that PrA is traced by hand and are therefore not dependent on assigning the same score to an entire pre‐specified segment which may only be partly affected.…”

“…for strain in the literature, 7 especially when contrast agents are not used. 9 Whereas strain provides a more granular assessment of the severity of the wall motion abnormalities across regions, PrA and PrAH provides an easily interpretable measure for the extent of myocardial akinesia (or the extent of the myocardium with any WMA, i.e. affected myocardium).…”

“…Compared to WMSI and other semi‐quantitative segment‐based methods, PrA allows for a more detailed quantification of the extent of regional myocardial dysfunction. PrA is less dependent on excellent image quality than more advanced methods, such as speckle‐tracking based methods, for assessing regional myocardial strain 8 ; and the agreement was greater in our study for PrA than what has typically been reported for strain in the literature, 7 especially when contrast agents are not used 9 . Whereas strain provides a more granular assessment of the severity of the wall motion abnormalities across regions, PrA and PrAH provides an easily interpretable measure for the extent of myocardial akinesia (or the extent of the myocardium with any WMA, i.e.…”

Low-cost 3D-printed anthropomorphic cardiac phantom, for computed tomography automatic left ventricle segmentation and volumetry – A pilot study

“…We did not perform MRI of the phantom for comparison to a gold standard. The primary benefit of MRI over CT is superior temporal resolution, 26 which is irrelevant in a stationary phantom. The spatial resolution of MRI is significantly lower than CT, with slice thicknesses typically in the range from 4 to 10 mm, compared to 0.6e2 mm for CT, making for theoretically more precise CT volumetry in the absence of motion.…”

Cardiac magnetic resonance in ischemic cardiomyopathy: present role and future directions

“…Based on volumetric (three-dimensional) approaches, CMR provides measurements that are free from geometric assumptions and are characterized by unbeatable levels of intra- and inter-operator reproducibility. 3 , 4 …”