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Canadian Journal of Cardiology

A SIMPLIFIED APPROACH TO MEASURING LVEF USING REGIONAL WALL MOTION

      Background

      Left ventricular ejection fraction (LVEF) is important for management and prognostication of various cardiac diseases and is the most common measure of LV function. Biplane Simpson’s method is recommended when using echocardiography, but can be cumbersome, time-consuming and not possible in many patients. An easy to use and accurate method to derive LVEF would be extremely useful for clinical practice. The purpose of this study was (1) to validate a simplified approach to estimating LVEF by echocardiography using regional wall motion (SEF) by comparison with radionuclide ventriculography, and (2) to compare the SEF method with the LVEF reported by Level 3 echocardiographers in an academic hospital.

      Methods

      We identified 186 consecutive patients who had LVEF calculated by both radionuclide ventriculography and echocardiography within 90 days of each other during a 1 year period. SEF was calculated using the completed wall motion analysis by subtracting 4% for each akinetic or worse segment and 2% for each hypokinetic segment from a total of 64% (16 segments, each valued at 4%). SEF was compared to the LVEF calculated by radionuclide ventriculography (MEF). SEF was also compared to the LVEF reported by Level 3 echocardiographers (REF), and in the patient subgroups using biplane Simpson’s method, Teichholz method and visual estimate.

      Results

      The results are summarized in the table below. In the 186 patients, both SEF and REF correlated highly with MEF with correlation coefficients of 0.80 and 0.83 respectively. Moreover, SEF was non-inferior to REF in correlating with MEF. However, REF significantly overestimated MEF as compared to SEF (REF 4.7% vs. SEF 1.6%; p =< 0.0001). The correlation coefficients for SEF vs. MEF and REF vs. MEF were similar when analyzed in the patient subgroups using biplane Simpson’s method, Teichholz method and visual estimate.

      Conclusion

      SEF is a simple, easy to use method to estimate LVEF and is non-inferior to previously validated echocardiography-derived LVEF Methods. In addition, overestimation of LVEF by Level 3 echocardiographers when compared to radionuclide ventriculography is reduced using this simplified approach.
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