Improving Quantitation of Left Ventricular Ejection Fraction in a Tertiary Echocardiography Lab- Merging Guidelines with Practice

Abstract

Background: The American Society of Echocardiography strongly recommend quantitative assessment of LVEF on transthoracic echocardiographic (TTE) by 2DE; Modified Simpson's rule or 3D echocardiography (3DE) where available. Purpose: To assess whether education and implementation of the guidelines results can improve the performance and reporting of 2DE/3DE quantitative LVEF and quality improvement. To validate whether the use of automated 3D technology (Philips HeartModelA.I.(HM)) can produce accurate and reproducible online 3DE measurements of LVEF. Methods: Consecutive TTE studies performed over a month prior to and after education intervention and guideline implementation were included. Baseline TTE studies were assessed whether quantitative LVEF was performed by the sonographer and included in the final report by the cardiologist. HM was then utilised prospectively and correlated with conventional 3DE LVEF as the reference. Results: 1422 TTEs (664 before and 758 after intervention) were included. Pre-intervention, the quantitative LVEF was calculated in 27% and 33% were included in the final report. Following educational intervention, these increased to 45% and 52% respectively. 3DE LVEF (by HM) in 48 patients demonstrated good correlation and agreement with conventional 3D LVEF (intraclass correlation coefficient 0.89; p < 0.0001)and good test-retest reproducibility (intra-observer variability 0.2 + -1.0% and inter-observer variability 2.7 + - 2.8%). Conclusions: In a busy clinical echocardiography laboratory, over-reliance on visual estimation of LVEF remains common. Education and implementation of guidelines improves confidence, performance, and reporting of quantitative 2DE LVEF. Incorporation of new automated technology 3DE LVEF (using HM) is feasible, accurate and reproducible.