Comparison of four echocardiographic techniques for measuring left ventricular ejection fraction


      Accurate quantitative measurement of left ventricular (LV) ejection fraction (EF) by 2-dimensional echocardiography is limited by subjective visual endocardial border detection. Both harmonic and precision contrast microbubbles provide better delineation of endocardial borders than fundamental imaging. The aim of this study was to correlate 2-dimensional echocardiographic quantification of LVEF measured by 4 currently available techniques with radionuclide angiography. A total of 50 patients who underwent radionuclide (EF) measurement (47 of 50 had technically difficult echocardiograms by fundamental imaging) underwent echocardiography by 4 methods: fundamental alone, fundamental with contrast, harmonic alone, and harmonic with contrast. Three echocardiologists measured the biplane 2-dimensional echocardiographic LVEF independently and were blinded to radionuclide angiography. The correlation of echocardiographic EF with radionuclide EF improved incrementally with each method. However, contrast with harmonic imaging provided the closest correlation (r = 0.95, 0.96, and 0.95 as assessed by the 3 independent analysts.
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        • Spencer K.T
        • Bednarz J
        • Rafter P.G
        • Korcarz C
        • Lang R
        Use of harmonic imaging without echocardiographic contrast to improve two-dimensional image quality.
        Am J Cardiol. 1998; 82: 794-799
        • Kasprzak J.D
        • Paelinck B
        • Ten Cate F.J
        • Vletter W.B
        • de Jong N
        • Poldermans D
        • Elhendy A
        • Bouakaz A
        • Roelandt J.R
        Comparison of native and contrast-enhanced harmonic echocardiography for visualization of LV endocardial border.
        Am J Cardiol. 1999; 83: 211-217
        • Gottsauner-Wolf
        • Schedlmayer-Duit J
        • Porenta G
        • Gwechenberger M
        • Huber K
        • Glogar D
        • Probst P
        • Sochor H
        Assessment of LV function.
        Eur J Nucl Med. 1996; 23: 1613-1618
        • Mueller X
        • Stauffer J.C
        • Jaussi A
        • Goy J.J
        • Kappenberger L
        Subjective visual echocardiographic estimate of LV EF as an alternative to conventional echocardiographic methods.
        Clin Cardiol. 1999; 14: 898-907
        • Schiller N.B
        • Shah P.M
        • Crawford M
        • DeMaria A
        • Devereux R
        • Feigenbaum H
        • Gutgesell H
        • Reicheck N
        • Sahn D
        • Schnittger I
        • Silverman N.H
        • Tajik A.J
        Recommendations for quantification of the left ventricle by 2 dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee of Quantitation of two dimension echocardiograms.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Bland J.M
        • Altman D.G
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
      1. Zaret BL, Wackers FJTh, Terrin ML, Forman SA, Williams DO, Knatterud GL, Braunwald E. Value of radionuclide rest and exercise LVEF in assessing survival of patients after thrombolytic therapy for acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction phase II study. J Am Coll Cardiol 1995;26:73–79.

        • Pfeffer M.A
        • Braunwald E
        • Moye L.A
        • Basta L
        • Brown E.J
        • Cuddt T.E
        • Davis B.R
        • Geltman E.M
        • Goldman S
        • Flaker G.C
        • et al.
        Effect of captopril on mortality and morbidity in patients with LV dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement trial.
        N Engl J Med. 1992; 327: 669-677
        • Alexander J
        • Dainiak N
        • Berger H.J
        • Goldman L
        • Johnstone D
        • Reduto L
        • Duffy T
        • Schwartz P
        • Gottschalk A
        • Zaret B.L
        Serial assessment of doxorubicin cardiotoxicity with quantitative radionuclide angiocardiography.
        N Engl J Med. 1979; 300: 278-283
        • Burns P.N
        • Wilson S.R
        • Muradali D
        • Powers J.E
        • Fritzch T.T
        Microbubble destruction is the origin of harmonic signals from FS069.
        Radiology. 1996; 201: 158
        • DeJong N
        • Ten Cate F.J
        • Lance C.T
        • Roelandt J.R
        • Bom N
        Principles and recent developments in ultrasound contrast agents.
        Ultrasonics. 1991; 29: 324-330
        • Senior R
        • Sridhara S
        • Basu S
        • Henley M
        • Handler C.E
        • Raftery E.B
        • Lahiri A
        Comparison of radionuclide ventriculography and 2D echocardiography for the measurement of LV EF following acute myocardial infarction.
        Eur Heart J. 1994; 15: 1235-1239
        • Van Royen N
        • Jaffe C.C
        • Krumholz H.M
        • Johnson K.M
        • Lynch P.J
        • Natale D
        • Atkinson P
        • Deman P
        • Wackers F.J
        Comparison and reproducibility of visual echocardiographic and quantitative radionuclide LVEFs.
        Am J Cardiol. 1996; 77: 843-850
        • Jensen-Urstad K
        • Bouvier F
        • Hojer J
        • Ruiz H
        • Hutling J
        • Samad B
        • Thorstrand C
        • Jensen-Urstad M
        Comparison of different echocardiographic methods with radionuclide imaging for measuring LV EF during acute myocardial infarction treated by thrombolytic therapy.
        Am J Cardiol. 1998; 81: 538-544
        • Hundley W.G
        • Kizilbash A.M
        • Afridi I
        • Franco F
        • Peshock R.M
        • Grayburn P.A
        Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of LV volumes and EF.
        J Am Coll Cardiol. 1998; 32: 1426-1432