Left ventricular ejection fraction in patients with normal and distorted left ventricular shape by three-dimensional echocardiographic methods: A comparison with radionuclide angiography

Background: Serial evaluation of left ventricular (LV) ejection fraction (EF) is important for the management and follow-up of cardiac patients. Our aim was to compare LVEF calculated from two three-dimensional echocardiographic (3DE) methods with multigated radionuclide angiography (RNA), in patients with normal and abnormally shaped ventricles. Methods and Results: Forty-one consecutive patients referred for RNA underwent precordial rotational 3DE acquisition of 90 cut-planes. From the volumetric data set, LVEF was calculated by (a) Simpson's rule (3DS) through manual endocardial tracing of LV short-axis series at 3 mm slice distance and (b) apical biplane modified Simpson's method (BMS) in 29 patients by manual endocardial tracing of the apical four-chamber view and its computer-derived orthogonal view. Patients included three groups: A, 17 patients with LV segmental wall motion abnormalities; B, 13 patients with LV global hypokinesis; and C, 11 patients with normal LV wall motion. For all the 41 patients, there was excellent correlation, close limits of agreement, and nonsignificant difference between 3DS and RNA for LVEF calculation (r = 0.99, [-6.7, +6.9] and p = 0.9), respectively. For the 29 patients, excellent correlation and nonsignificant differences between LVEF calculated by both 3DS and EMS and values obtained by RNA were found (r = 0.99 and 0.97, p = 0.7 and P = 0.5, respectively). In addition, no significant difference existed between values of LVEF obtained from RNA, 3DS, and EMS by the analysis of variance (p = 0.6). The limits of agreement tended to be closer between 3DS and RNA (-6.8, +7.2) than between EMS and RNA (-8.3, +9.7). The intraobserver and interobserver variability of RNA, 3DS, and EMS for calculating LVEF(%) were (0.8, 1.5), (1.3, 1.8), and (1.6, 2.6), respectively. There were closer limits of agreement between 3DS and RNA for LVEF calculation in A, B, and C patient subgroups [(-3.5, +5), (-8.4, +5.6), and (-7.8, +8.6)] than that between EMS and RNA [(-8.1, +10.7), (-11.9, +9.3), and (-9.1, +11.3)], respectively. Conclusions: No significant difference existed between RNA, 3DS, and EMS for LVEF calculation. 3DS has better correlation and closer limits of agreement than EMS with RNA for LVEF calculation, particularly in patients with segmental wall motion abnormalities and global hypokinesis. 3DS has a comparable observer variability with RNA. Therefore the use of 3DS for serial accurate LVEF calculation in cardiac patients is recommended.