Author(s): Mueller X, Stauffer JC, Jaussi A, Goy JJ, Kappenberger L, Mueller X, Stauffer JC, Jaussi A, Goy JJ, Kappenberger L
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Abstract Left ventricular ejection fraction (LVEF) is a measure of ventricular function with clinical and prognostic significance and can be reliably calculated with various M-mode and two-dimensional echocardiographic formulas in selected, good quality echocardiograms. Subjective visual echocardiographic estimate of LVEF is a potentially less time consuming and more widely applicable method. In order to test its reliability, we performed a prospective blind trial in 40 consecutive patients undergoing biplane contrast ventriculography (BCV), to compare the visual estimate of LVEF during a complete echocardiogram of three independent observers with (1) cubed M-mode formula, (2) Teichholz M-mode formula, (3) length-area method from the four-chamber view, and (4) Simpson's single plane formula. BCV was the reference method. The best correlation with BCV was obtained by visual estimate [r of the three observers, respectively = 0.75; 0.84; 0.81] and M-mode measurements [r (1) = 0.8; r (2) = 0.8], but the most sophisticated methods provided the poorest estimate [r (3) = 0.54; r (4) = 0.49]. All correlation coefficients improved when good studies, defined as a definition of the endocardial surface of more than 75\%, were selected (n = 23), but the differences persisted. One observer systematically estimated higher values than the other two (Friedman's test, p less than 0.01) and this interobserver variability suggests that each echocardiographer should test himself against BCV in his lab in order to apply the visual estimate method reliably.
This article was published in Clin Cardiol
and referenced in Journal of Blood Disorders & Transfusion