Variability in Ejection Fraction Measured By Echocardiography, Gated Single-Photon Emission Computed Tomography, and Cardiac Magnetic Resonance in Patients With Coronary Artery Disease and Left Ventricular Dysfunction

Abstract

Key Points Question What is the variability in left ventricular ejection fraction (LVEF) as measured by different cardiac imaging modalities? Findings In this multicenter diagnostic study of 2032 patients with coronary artery disease and LVEF of 35% or less with imaging interpreted by core laboratories, correlation of LVEF between modalities ranged from r = 0.493 (for biplane echocardiography and cardiovascular magnetic resonance) to r = 0.660 (for cardiovascular magnetic resonance and gated single-photon emission computed tomography). There was no systematic overestimation or underestimation of LVEF for any modality. Meaning There is substantial variability in LVEF assessment between modalities, which should be considered in trial design and clinical management.

Timely-Automatic Procedure for Estimating the Endocardial Limits of the Left Ventricle Assessed Echocardiographically in Clinical Practice

“…Often, time consuming and expensive diagnostic methods such as MRI and SPECT, or even invasive ones, are required, exposing the patient to an additional risk. In some studies [3,4], it is estimated that about 15% of routine echocardiograms and up to 30% of those performed on patients with poor acoustic window are suboptimal. Reduced EBD represents a pitfall of echocardiogram without contrast.…”

“…At first, the international societies of echocardiography have developed rigorous protocols for the acquirement and measurement of cardiac structures [2], and then, transesophageal ultrasonography (TEE) or the use of contrast agents for an improved EBD were recommended [3]. Other possibilities, in suboptimal echocardiographic assessments, are cardiac magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), or invasive methods, causing increased medical cost and healthcare system burden [4]. Finally, progresses in the field of digital image processing attempted to provide alternative solutions [5,6].…”

Opções Contemporâneas de Rastreio da Cardiotoxicidade Relacionada a Tratamentos Oncológicos

“…Os dois métodos têm suas limitações. Enquanto a sensibilidade de detecção das disfunções ventriculares pode estar diminuída no ecocardiograma bidimensional em pacientes com obesidade e doença pulmonar, no MUGA pode haver falha na mensuração da FEVE em pacientes com arritmias 26 . Adicionalmente, o ecocardiograma transtorácico apresenta relação custo-benefício favorável e inócua ao paciente, sendo eventualmente utilizado inclusive como método alternativo na confirmação de algumas mensurações em que o MUGA é limitado e requer exposição à radiação 27 .…”

Biomarkers in Heart Failure With Preserved Ejection Fraction: An Update on Progress and Future Challenges

“…Current use of left ventricular ejection fraction (LVEF) cutoff points to arbitrarily define HFpEF, and its counterpart HFrEF may be an oversimplification [17]. It remains unclear if HFpEF may be a unique syndrome compared to HFrEF [18], or if there is significant overlap in their underlying pathophysiologies and disease phenotypes [19]. Measurement of LVEF is imprecise as it can fluctuate significantly depending on loading conditions, imaging modality used, and inter-observer variability [19].…”

“…It remains unclear if HFpEF may be a unique syndrome compared to HFrEF [18], or if there is significant overlap in their underlying pathophysiologies and disease phenotypes [19]. Measurement of LVEF is imprecise as it can fluctuate significantly depending on loading conditions, imaging modality used, and inter-observer variability [19]. LVEF is also less sensitive in HFpEF than other imaging calculations such as global longitudinal strain at detecting systolic dysfunction [20] and predicting mortality [21].…”