Segmental Model for Estimating Left Ventricular Ejection Fraction by Two-Dimensional Echocardiography: Comparison with Gated Blood Pool Scanning

Abstract

Left ventricular ejection fraction was determined by two-dimensional echocardiography in 54 patients using a new method, and the results were compared with the ejection fraction by gated blood pool scanning. The ventricle was modelled as a tubular base section joined to a hemielliptical apex section, each containing four quadrants. Segmental contraction was scored in twelve regions of the ventricle by visual assessment of wall motion during videotape playback of echocardiograms. The twelve contraction scores were converted to dimensional shortening and used to calculate separate ejection fractions for each of the eight quadrants. These eight values were averaged to obtain the left ventricular global ejection. Fifty-eight patients with echocardiograms and gated scans within 7 days of each other were selected retrospectively from among the routine studies in the clinical laboratory. Image quality was adequate for wall motion scoring in 54 patients. The correlation coefficient between echocardiography and gated scanning was 0.92 with a standard error of 7.5. The accuracy of the method was very similar for studies with the most homogeneous wall motion compared to those with the most dyssynergy and in patients with the lowest ejection fractions compared to those with the highest ejection fractions. In 31 patients, scoring of contraction was performed independently by two different observers. Both observers attained an identical correlation with gated scan of 0.92. The interobserver correlation coefficient was also 0.92 with a standard error of 7.8. It is concluded that this method of estimating left ventricular ejection fraction is simple to use and may provide a clinically acceptable degree of accuracy in a wide variety of conditions of left ventricular function.

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

“…Despite the relative lack of accuracy of wall motion index and of the proposed wall motion derived estimate of LVEF, these indices neverthe less appear sufficiently accurate to contribute to the solu tion of clinical problems [4,34,35]. It is possible that a closer approximation of linearity could be obtained by giving wall motion scores from different segments differ ent weight in the index as suggested by Rifkin et al [27] and Rifkin and Koito [28]; however at the cost of increased complexity. The reproducibility of wall motion index was not examined in this study, but a low interob server variability has previously been shown [4,30], Finally, it should be kept in mind that part of the described imprecision may be due to the fact that the radionuclide reference method used in this study -for the purpose of comparison -was defined as giving a true LVEF which is not quite the case.…”

“…The use of wall motion analysis for estimating LVEF was recently proposed by Berning et al [4] in a series of 201 patients after acute myocardial infarction and by Rifkin et al [27] and Rifkin and Koito [28] in a series of 54 patients with various types of heart disease (25 with wall motion abnor malities), but otherwise the linear relation between wall motion index and LVEF has received little attention [28], Statistical analysis showed that among the simple écho cardiographie parameters, only wall motion index and left ventricular end-systolic dimension had a significant rela tion to radionuclide LVEF in a multiple regression model. This was somewhat surprising, since a considerable body of literature documents that the E point septal distanceand not the end-systolic dimension -is the best M-mode parameter for prediction of LVEF by linear regression analysis ( fig.…”

Performance of a Simplified Wall Motion Score Index Method for Noncardiologists to Assess Left Ventricular Ejection Fraction

“…The index (WMSI) is calculated by dividing the total of the wall motion scores of each segment by 16. We have previously reported the linear regression model predicting RNV LVEF by WMSI [3] and several other studies have documented the good correlation of WMSI to LVEF [5][6][7][8][9].…”

Radial and Axial Fractional Shortening for Rapid Estimation of Left Ventricular Ejection Fraction: A Computational Analysis

“…Accordingly, a variety of alternative methods for assessing LV function have evolved. Visual based segmental scoring schemes have been used as a semi-quantitative surrogate for EF when planimetry is not feasible and segmental wall motion abnormalities (SWMA) are present [3,4]. However, these alternatives are difficult to apply in cases of uniform LV dysfunction in the absence of a normally contracting segment to use as a visual benchmark.…”