Left Ventricular End Diastolic Volume and Ejection Fraction Calculation: Correlation between Three Echocardiographic Methods.

Nadia Benyounes,Thierry Tibi,Clélie Van Der Vynckt,Alexandra Iglesias,Olivier Gout,Laurence Salomon,Sylvie Lang

doi:10.1155/2020/8076582

Abstract

Background Left ventricular ejection fraction (LVEF) and end diastolic volume (EDV) are measured using Simpson's biplane (SB), 3-dimensional method (3DE), and speckle tracking (STE). Comparisons between methods in routine practice are limited. Our purpose was to compare and to determine the correlations between these three methods in clinical setting. Methods LVEF and EDV were measured by three methods in 474 consecutive patients and compared using multiple Bland–Altman (BA) plots. The correlations (R) between methods were calculated. Results Median (IQR) LVEF_SB, LVEF_STE, and LVEF_3DE were 63.0% (60–69)%, 61% (57–65)%, and 62% (57–68)%. Median (IQR) EDV_SB, EDV_STE, and EDV_3DE were 85 ml (71–106) ml, 82 ml (69–100) ml, and 73 ml (59–89) ml. R between LVEF_SB and LVEF_3DE was 0.65 when echogenicity was good and 0.43 when poor. R for EDV_SB and EDV_3DE was 0.75 when echogenicity was good and 0.45 when poor. On BA analysis, biases were acceptable (<3.5% for LVEF) but limits of agreement (LOA) were large: 95% of the differences were between −15.4% and +18.8% for LVEF as evaluated by SB in comparison with 3DE, with a bias of 1.7%. In the comparison EDV_SB and EDV_3DE, the bias was 14 ml and the LOA were between −24 ml and +53 ml. On linear regressions, LVEF_3DE = 17.92 + 0.69 LVEF_SB and EDV_3DE = 18.94 + 0.63 EDV_SB. Conclusions The three methods were feasible and led to acceptable bias but large LOA. Although these methods are not interchangeable, our results allow 3DE value prediction from SB, the most commonly used method.

Highlights

Transthoracic echocardiography (TTE) is the most commonly used diagnostic tool for left ventricular (LV) systolic dysfunction. e new guidelines state that LV systolic function should be routinely assessed using two-dimensional echocardiography (2DE) or three-dimensional echocardiography (3DE) [1]
Ree-dimensional echocardiography: Left ventricular ejection fraction (LVEF) and end diastolic volume (EDV) measurements were performed after a 3D image acquisition including the entire LV within the pyramidal data set (4 beats volume acquisition). e 3D-guided biplane analysis was the method used. e different steps were described elsewhere [6]
Among the consecutive TTEs performed during the study period, 39 were excluded because of atrial fibrillation and an additional 65 because more than one LVEF and/or EDV methods of measurement were not performed

Summary

Introduction

Transthoracic echocardiography (TTE) is the most commonly used diagnostic tool for left ventricular (LV) systolic dysfunction. e new guidelines state that LV systolic function should be routinely assessed using two-dimensional echocardiography (2DE) or three-dimensional echocardiography (3DE) [1]. Few data exist regarding the agreement between LVEF and EDV as determined by these different methods, in clinical practice. LVEF and EDV were calculated by the three methods almost simultaneously, in a predefined sequence, in all patients: Simpson’s biplane method, 3DE, and STE, were performed according to current guidelines [1]. Simpson’s biplane method: LVEF was calculated using the manual tracing on apical four and apical two-chamber views. Ree-dimensional echocardiography: LVEF and EDV measurements were performed after a 3D image acquisition including the entire LV within the pyramidal data set (4 beats volume acquisition). Pearson’s correlation coefficient was used to analyse correlations between LVEFs and EDVs when calculated by two different methods.

Results

Echocardiographic Findings

Method

Study Limitations