Baseline LV ejection fraction by cardiac magnetic resonance and 2D echocardiography after ST-elevation myocardial infarction \u2013 influence of infarct location and prognostic impact

Johannes P Schwaiger,Magdalena Holzknecht,Sebastian J Reinstadler,Gert Klug,Bernhard Metzler,Martin Reindl,Silvana Müller,Ivo Graziadei,Christina Tiller,Agnes Mayr

doi:10.1007/s00330-019-06316-3

Abstract

ObjectivesThe comparability of left ventricular ejection fraction (LVEF) measurements by cardiac magnetic resonance (CMR) and 2D echocardiography (2DE) early after ST-elevation myocardial infarction (STEMI) remains unclear.MethodsIn this study, LVEF measured by CMR and 2DE (Simpson’s method) were compared in 221 patients after STEMI treated by primary percutaneous coronary intervention. 2DE image quality was systematically assessed and studies reported by an accredited examiner. Intermodality agreement was assessed by the Bland–Altman method. Major adverse cardiac events (MACE) were defined as the composite of death, myocardial infarction or hospitalisation for heart failure. Patients were followed up for a median of 40.9 months (IQR 28.1–56).ResultsAfter non-anterior STEMI, LVEF measurements by 2DE (single and biplane) were consistently underestimated in comparison to CMR (CMR 55.7 ± 9.5% vs. 2DE-4CV 49 ± 8.2% (p = 0.06), 2DE-2CV 52 ± 8% (p < 0.001), 2DE-biplane 53.5 ± 7.1% (p = 0.01)). After anterior STEMI, there was no significant difference in LVEF measurements by 2DE and CMR with acceptable limits of agreement (CMR 49 ± 11% vs. 2DE-4CV 49 ± 8.2% (p = 0.8), 2DE-2CV 49 ± 9.2% (p = 0.9), 2DE-biplane 49.6 ± 8% (p = 0.5)). In total, 15% of patients experienced a MACE during follow-up. In multivariate Cox regression analysis, reduced LVEF (< 52%) as assessed by either 2DE or CMR was predictive of MACE (2DE HR = 2.57 (95% CI 1.1–6.2), p = 0.036; CMR HR = 2.51 (95% CI 1.1–5.7), p = 0.028).ConclusionsAt baseline after non-anterior STEMI, 2D echocardiography significantly underestimated LVEF in comparison to CMR, whereas after anterior infarction, measurements were within acceptable limits of agreement. Both imaging modalities offered similar prognostic values when a reduced LVEF < 52% was applied.Key Points• After non-anterior STEMI, 2D-echocardiography significantly underestimated LVEF compared with cardiac MRI• An ejection fraction of < 52% in the acute post-infarct period by both 2D echocardiography and CMR offered similar prognostic values

Highlights

Left ventricular ejection fraction (LVEF) is of major prognostic importance in many cardiac diseases, in particular after STsegment elevation myocardial infarction (STEMI) [1,2,3,4]
Particular emphasis was put on retrospective assessment of 2D echocardiography (2DE) image quality; all studies were reported by an individual with the appropriate experience and accreditation
323 STEMI patients were enrolled into the cardiac magnetic resonance (CMR) database

Summary

Introduction

Left ventricular ejection fraction (LVEF) is of major prognostic importance in many cardiac diseases, in particular after STsegment elevation myocardial infarction (STEMI) [1,2,3,4]. Guidelines recommend transthoracic echocardiography before discharge after STEMI to assess for infarct size and resting LV function, identifying patients at high risk for worse outcome [5] It provides important information about diastolic function in the acute phase [6]. Its accuracy is dependent on the examiner’s experience and training and offers only moderate reproducibility [10, 11] For these reasons, cardiac magnetic resonance (CMR) imaging has evolved into the gold-standard imaging method of systolic function [12,13,14]; few studies have compared ejection fraction measurements determined by 2DE and CMR in the immediate post-infarct period. None of these studies has systematically assessed 2DE quality or has taken infarct location into consideration

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