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PubMed1991

Placement considerations for measuring thermodilution right ventricular ejection fractions.

BACKGROUND AND METHODS: Clinical examination of right ventricular (RV) performance has been hampered by the inability to measure easily RV volumes and ejection fraction. This study was performed to examine the effects of catheter position on thermodilution RVEF measurements. Six pigs (80 to 100 kg) were instrumented with an RV thermodilution catheter in the pulmonary artery, an injectate catheter in the right atrium, an atrial pacing electrode, and a systemic arterial catheter. RVEF measurements were determined using thermodilution in two ways: a) with incremental increases in pulmonary valve to thermistor distance; and b) with incremental increases in injectate port to tricuspid valve distance. These measurements were obtained at a paced rate of 102 +/- 2 beats/min and then repeated with pacing-induced tachycardia (140 beats/min). RESULTS: There was no significant difference in thermodilution RVEF measurements with the thermistor positioned 0 to 10 cm from the pulmonary valve at either heart rate. A significant reduction in RVEF occurred with the injection port located 5 to 7 cm proximal to the tricuspid valve, with this decrease becoming more pronounced during tachycardia. CONCLUSIONS: These results demonstrate that RVEF measurements can be reliably obtained using thermodilution. In these large hearts, thermodilution RVEF measurements appear to be independent of thermistor position within the pulmonary artery. However, large distances from injectate port to tricuspid valve reduced RVEF measurements.

Animals↗
PubMed1998

Correlation of gallbladder ejection fraction with pathologic grade for chronic inflammation.

BACKGROUND: The purpose of this study is to define the sensitivity and specificity of the gallbladder ejection fraction (GBEF) for identifying patients with various grades of histologically proven chronic cholecystitis. METHODS: Of 693 consecutive patients who had a scintigraphic GBEF determination at Baptist Medical Center of Oklahoma, 161 subsequently had a cholecystectomy at the same institution. Pathologic material was reassessed by one outside blinded reviewer, who graded the intensity of the inflammation present on a 0 (absent) to 3 (most severe) scale. RESULTS: The least square mean maximum GBEF was 23.7% for those with grade 0, 9.6% for those with grade 3, and 13.9% for those with cholesterolosis. If a normal value for GBEF is set at > 30%, the sensitivity for detecting grade 1, 2, or 3 disease was 84%, and the specificity was 26%. For grade 3 disease alone, the sensitivity was 100%, and the specificity was 26%. CONCLUSIONS: The GBEF is sensitive but not specific for chronic inflammation of the gallbladder. The GBEF appears to be useful as a screening examination in the appropriate clinical setting.

Cholecystitis↗
PubMed1999

Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography.

BACKGROUND: The incremental prognostic value of post-stress left ventricular ejection fraction (EF) and volume over perfusion has not been investigated. METHODS AND RESULTS: We identified 1680 consecutive patients who underwent rest Tl-201/stress Tc-99m sestamibi gated single photon emission computed tomography (SPECT) and who were followed-up for 569+/-106 days. Receiver-operator characteristics analysis defined an EF<45%, an end-systolic volume (ESV) >70 mL, and an end-diastolic volume >120 mL as optimal thresholds, yielding moderate sensitivity and high specificity in the prediction of cardiac death. Patients with an EF> or = 45% had mortality rates <1%/year, despite severe perfusion abnormalities, whereas patients with an EF<45% had high mortality rates, even with only mild/moderate perfusion abnormalities (9.2%/year; P<0.00001). Similarly, an ESV< or = 70 mL was related to a low cardiac death rate (<1.2%/year), even for patients with severe perfusion abnormalities, whereas patients with an ESV>70 mL and only mild/moderate perfusion abnormalities had high death rates (8.2%/year; P<0.00001). Patients with an EF<45% and an ESV< or = 70 mL had low cardiac death rates (1.7%/year); those with an EF<45% but an ESV>70 mL had high death rates (7.9%/year; P<0.02). Multivariate Cox proportional hazards regression showed that perfusion variables and ESV were independent predictors of overall coronary events, whereas EF and ESV demonstrated incremental prognostic values over prescan and perfusion information in predicting cardiac death and cardiac death or myocardial infarction. CONCLUSIONS: Post-stress EF and ESV by gated-SPECT have incremental prognostic values over prescan and perfusion information in predicting cardiac death, and they provide clinically useful risk stratification.

Adenosine↗
PubMed1977

Immediate effect of contrast medium injection on left ventricular volumes and ejection fraction. A study using metallic epicardial markers.

The immediate effect of contrast medium injection on left ventricular (LV) volume, stroke volume (SV) and ejection fraction (EF) was evaluated from postoperative LV biplane cineangiograms of 10 patients with 4-6 epicardial markers placed at the time of coronary artery surgery. After calibrating marker distances with respect to volume (r = 0.97-0.99) over one cardiac cycle for each patient, regression equations were used to compute LV volume from marker measurements for beats prior to, during and following injection. End-diastolic volumes (EDV) prior to injection ranged from 93-263 ml and did not change significantly with injection. End-systolic volumes (ESV) showed a mean decrease of 7.3 ml by beat 7 following injection; this was of borderline significance. Similarly, there was no significant change of SV or EF until beat 7 when there were small but significant increases of 6.4 ml and 0.04, respectively. The injection of moderate amounts of contrast in man does not cause significant changes in LV volume or EF through the sixth post-injection beat.

Cardiac Output↗
PubMed2004

Two-dimensional echocardiography estimation of right ventricular ejection fraction by wall motion score index.

BACKGROUND: Radionuclide angiography (RNA) and echocardiography (biplane Simpson method) are the most accepted methods for right ventricular ejection fraction (RVEF) evaluation. The authors tried to determine a new method to measure RVEF based on wall motion score index (WMSI). OBJECTIVES: One hundred forty-one patients with RV dysfunction had transthoracic echocardiography (TTE) evaluation of the right ventricle. In a first group of 54 patients, a correlation between RVEF using the biplane Simpson method (four chamber and two chamber [4C+2C]) and RV-WMSI was established from a polar map using an eight-segment model to find a regression equation. With the second group of 51 subsequent patients, this equation (RVEF=73.07-20.7 x WMSI), comparing the RVEF-WMSI with the biplane Simpson RVEF (4C+2C), was validated. In a third group of 36 consecutive patients with abnormal RV contractility, the RVEF was calculated by RNA and this RVEF was correlated to the RV-WMSI. RESULTS: The first group of 54 patients had a correlation coefficient of 0.84 between WMSI and RVEF (biplane Simpson method). The results from the second group of 51 patients with RVEF derived from the estimated regression equation correlated well with the biplane Simpson RVEF (r=0.84). The correlation coefficient for these two groups taken together (105 patients), that is, between WMSI and RVEF (biplane Simpson method), was 0.92. The third group of 36 patients with RNA-EF displayed a correlation coefficient of 0.83 with RV-WMSI. CONCLUSION: This new semiquantitative method for estimating RVEF from RV-WMSI is easy to use in routine TTE and shows an excellent correlation with the biplane Simpson method and RNA.

Adolescent↗
PubMed2004

Constancy and variability of gallbladder ejection fraction: impact on diagnosis and therapy.

UNLABELLED: The main objective of this study was to test the constancy and variability of gallbladder (GB) ejection fraction (EF) in long-term studies to (a) determine whether EF ever becomes normal once it is low, (b) determine how long it takes for the EF to become abnormal once it is found to be normal, (c) explore the cause of low EF, and (d) define objective parameters for biliary and nonbiliary abdominal pain. METHODS: Fifty-two patients (42 women, 10 men) who underwent quantitative cholescintigraphy twice (total studies, 104), over a mean period of 38.54 mo between studies, were chosen for retrospective analysis. They were divided into the following groups: control (n = 13; nonbiliary abdominal pain), chronic acalculous cholecystitis (CAC) (n = 27; biliary abdominal pain), chronic calculous cholecystitis (CCC) (n = 6; biliary abdominal pain), and opioid (n = 6; nonbiliary abdominal pain). The last group had received an opioid before cholecystokinin-8 (CCK-8) infusion in one study but not in the other study. A GBEF value of > or =35% was considered normal with a 3-min infusion and > or =50% as normal with a 10-min infusion of CCK-8. RESULTS: The mean GBEF value was reproducible between the 2 sequential studies in the control group (66.0% +/- 20.5% vs. 73.9% +/- 17.7%), CAC group (24.4% +/- 22.3% vs. 16.9% +/- 10.9%), and CCC group (20.8% +/- 20.9% vs. 27.5% +/- 34.5%) but not in the opioid group (14.8% +/- 14.6% vs. 56.5% +/- 31.7%). The severity of GBEF reduction in CAC increased with time: 7.2% +/- 8.1% within 12 mo, 16.1% +/- 14.9% in 13-47 mo, and 23.5% +/- 21.3% in 48-168 mo. None of the 27 patients with CAC developed a gallstone as detected by ultrasound during the study period. In 5 patients with CAC, a mean period of 52.6 +/- 28.9 mo was required for conversion from normal to a low EF. CCK-induced cystic duct spasm is the etiology for low EF in both CAC and CCC. CONCLUSION: Normal and low GBEF values are reproducible in long-term studies. Once the EF reaches a low value, it does not return to normal, and a normal value requires many years to become abnormal. CCK-induced cystic duct spasm is the cause of low GBEF in CAC and CCC, and the severity of EF reduction is similar for both. Exclusion of opioid intake immediately before the study is critical before attributing a low GBEF value to an irreversible GB motor dysfunction.

Acalculous Cholecystitis↗
PubMedDate not supplied

Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography.

The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements, r = 0.93 (p less than 0.001). LVEF determined by multigated radionuclide cardiography was, however, significantly lower than when measured by cardioangiography, the mean difference being 6 per cent (p less than 0.001). These findings suggest that radionuclide determinations of SV and LVEF are reliable. The discrepancy between the non-invasive and invasive LVEF values raises the question, whether LVEF is overestimated by cardioangiography or underestimated by radionuclide cardiography.

Adult↗
PubMed1984

Right ventricular and left ventricular ejection fraction in pediatric patients with normal hearts: first-pass radionuclide angiocardiography.

First-pass radionuclide angiocardiography was used to estimate right ventricular (RV) ejection fraction (EF) and left ventricular (LV) EF in infants, children, and teenagers with normal hearts. The right ventricle was analyzed in 74 patients and the left ventricle in 72 patients. Mean RVEF for the group was 0.53 +/- 0.06 (range 0.43 to 0.73); mean LVEF for the group was 0.68 +/- 0.09 (range 0.49 to 0.86). Lower values tended to be present in younger patients. However, there was no statistical difference in EFs between age groups and no linear correlation between magnitude of EF and age or EF and heart rate for either ventricle. Data obtained demonstrated that RVEF and LVEF in children with normal hearts are similar to those in adults with normal cardiovascular systems. A RVEF of 0.41 to 0.47 or a LVEF of 0.50 to 0.59 would suggest borderline systolic function; a RVEF less than 0.41 (mean -2 SD) or LVEF less than 0.50 (mean -2 SD) would be considered abnormal when this technique of first-pass radionuclide angiocardiography is used.

Adolescent↗
PubMed1975

Left ventricular ejection fraction in severe chronic obstructive airways disease.

The subject of left ventricular involvement in chronic obstructive airways disease is controversial. We measured left ventricular ejection fraction (LVEF) in 120 patients with severe chronic obstructive airways disease, 92 of them acutely decompensated and 28 stable. A bedside radionuclide technic using a scintillation probe was used to measure LVEF. Of the 28 patients with acute respiratory failure, LVEF was normal (larger than or equal to 55 per cent) in 60 and subnormal in 32. Of the 28 patients with stable chronic obstructive airways disease, LVEF was normal in 12 and low in 16. Coronary artery disease could be demonstrated clinically or at autopsy in 13 of the patients with acute and in 7 of the patients with stable chronic obstructive airways disease. LVEF was 28 plus or minus 10.4 per cent (average plus or minus SEM) in the patients with acute chronic obstructive airways disease and coronary artery disease which was significantly different (P smaller than 0.001) from LVEF in patients without coronary artery disease (61 plus or minus 1.9 per cent). In the patients stable with chronic obstructive airways disease and coronary artery disease, LVEF was (42 plus or minus 3.5 per cent), significantly different (P smaller than 0.001) from LVEF in those without coronary artery disease (55 plus or minus 2.1 per cent). There was no relationship between LVEF and arterial oxygen, or carbon dioxide tension, or pH. Results suggest that LVEF is normal in patients with severe lung disease alone and that reduced LVEF in patients with chronic obstructive airways disease can reasonably be ascribed to coronary artery disease.

Acute Disease↗
PubMed1997

Validation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients > or = 65 years old.

We sought to validate a previously described clinical prediction rule for classifying left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). As part of the Connecticut cohort of the Cooperative Cardiovascular Project (CCP) pilot study, we identified 3,093 Medicare patients who had been admitted to hospitals throughout Connecticut with an AMI in 1992 and 1993. Retrospective chart review and detailed electrocardiogram interpretation were performed. Of the 1,891 patients with an interpretable EF, 1,378 (73%) had > or = 1 of the rule's exclusion criteria. Of the remaining 513 patients, the clinical prediction rule had a positive predictive value of 89% (i.e., 456 of 513 patients had an EF > or = 40%). In a multivariate model, presentation > 6 hours after the onset of chest pain, a history of bypass surgery, and diabetes mellitus were associated with patients in whom the rule did not correctly predict an EF > or = 40%. Excluding patients with these characteristics from the rule increased the positive predictive value from 89% to 93% and excluded an additional 239 patients. The EF could not be predicted among the patients who did not meet the rule's criteria. In conclusion, a previously published clinical prediction rule for the classification of the EF in patients after an AMI correctly classified 8 of every 9 eligible elderly patients as having an EF > or = 40%. Thus, while not performing as well as it did in the original study, our findings support the use of this rule in providing clinicians with an objective method for estimating an EF > or = 40% in a specific subset of elderly patients.

Aged↗
PubMed2003

Outcomes in heart failure patients with preserved ejection fraction: mortality, readmission, and functional decline.

OBJECTIVES: We evaluated the six-month clinical trajectory of patients hospitalized for heart failure (HF) with preserved ejection fraction (EF), as the natural history of this condition has not been well established. We compared mortality, hospital readmission, and changes in functional status in patients with preserved versus depressed EF. BACKGROUND: Although the poor prognosis of HF with depressed EF has been extensively documented, there are only limited and conflicting data concerning clinical outcomes for patients with preserved EF. METHODS: We prospectively evaluated 413 patients hospitalized for HF to determine whether EF >or=40% was an independent predictor of mortality, readmission, and the combined outcome of functional decline or death. RESULTS: After six months, 13% of patients with preserved EF died, compared with 21% of patients with depressed EF (p = 0.02). However, the rates of functional decline were similar among those with preserved and depressed EF (30% vs. 23%, respectively; p = 0.14). After adjusting for demographic and clinical covariates, preserved EF was associated with a lower risk of death (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.26 to 0.90; p = 0.02), but there was no difference in the risk of readmission (HR 1.01, 95% CI 0.72 to 1.43; p = 0.96) or the odds of functional decline or death (OR 1.01, 95% CI 0.59 to 1.72; p = 0.97). CONCLUSIONS: Heart failure with preserved EF confers a considerable burden on patients, with the risk of readmission, disability, and symptoms subsequent to hospital discharge, comparable to that of HF patients with depressed EF.

Activities of Daily Living↗
PubMed2001

Lack of agreement between left ventricular volumes and ejection fraction determined by two-dimensional echocardiography and contrast cineangiography in postinfarction patients.

OBJECTIVE: To assess the agreement between left ventricular (LV) volumes and ejection fraction (EF) determined by two-dimensional echocardiography (2-D echo) and by cineangiography in postinfarction patients. DESIGN: LV end-diastolic and end-systolic volumes indexed (EDVI and ESVI) to body surface area as well as EF were determined by both methods in all patients. SETTING: Multicenter trial conducted in five university hospitals. PATIENTS: 63 patients, 61 male, two female, mean age 55.5 +/- 10.4 years, suffering from a recent myocardial infarction. Eighty-one pairs of measurements were available. METHODS: The results of biplane 2-D echo measures, using apical four-chamber (4C) and two-chamber (2C) views were compared to those of a 30 degrees right anterior oblique cineangiography projection, using either the apical method of discs or the area-length 2-D echo method. Moreover, eyeball EF was estimated at 2-D echo and cineangiography, and was compared to the conventional methods. The agreement between results was assessed by the Bland and Altman method. RESULTS: The agreement between 2-D echo and cineangiography results was poor. Mean differences (MD) were -21.8 (EDVI, ml/m(2)), -9.5 (ESVI, ml/m(2)), and -0.9 (EF, %), respectively for 2-D echo method of discs versus cineangiography, and -23.2, -9.3, and -5.7 for area-length 2-D echo versus cineangiography. For EF (%), MD was -3.6 for eyeball cineangiography versus cineangiography, -1.3 for eyeball 2-D echo versus method of discs, and +0.30 for eyeball 2-D echo versus area-length 2-D echo, respectively. Two-dimensional echo is likely to underestimate LV volumes compared to cineangiography, especially for largest volumes. Even for EF, discrepancies are large, with a lack of agreement of 21%-25% between conventional methods, but agreement is better between eyeball EF and usual methods. CONCLUSIONS: Even with modern echocardiographic devices, agreement between 2-D echo and cineangiography-derived LV volumes and EF remains moderate, and both methods must not be considered interchangeable in clinical practice.

Adult↗
PubMed2001

A prospective comparison of echocardiographic wall motion score index and radionuclide ejection fraction in predicting outcome following acute myocardial infarction.

OBJECTIVE: To characterise echocardiographic wall motion score index (WMSI) as a surrogate measure of left ventricular ejection fraction (EF) following acute myocardial infarction (AMI) and to compare its prognostic value with that of EF measured by radionuclide ventriculography (RNV). DESIGN: A prospective study to compare baseline echocardiographic WMSI with RNV EF in consecutive patients thrombolysed for AMI, both performed on the same day before discharge, and their relative prognostic values in predicting cardiac events. SETTING: District general hospital coronary care unit and cardiology department. PATIENTS: 120 consecutive patients free of exclusion criteria thrombolysed for AMI and followed up for a mean (SD) of 13 (10) months. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Correlation coefficients and receiver operating characteristic curve analyses plus cardiac event rates at follow up between RNV EF and echocardiographic WMSI. RESULTS: WMSI correlated well with RNV EF. The best corresponding WMSIs for EFs 45%, 40%, and 35% were 0.6, 0.8, and 1.1, respectively. There were 42 cardiac events during follow up. Although both RNV EF and WMSI were strong univariate predictors of cardiac events, only WMSI independently predicted outcome in a multivariate model. All three WMSI cut offs significantly predicted events, while an RNV EF cut off of </= 45% v > 45% failed to reach significance. CONCLUSIONS: Although both RNV and echocardiographic WMSI strongly predicted cardiac outcome, WMSI, a cheaper and more readily available technique, is more discriminatory, especially in cases of mild left ventricular dysfunction following AMI.

Adult↗
PubMed1994

Temporal influences on the prediction of postinfarction mortality by heart rate variability: a comparison with the left ventricular ejection fraction.

OBJECTIVE: To examine the influence of the duration of follow up on the values of heart rate variability (HRV) and the left ventricular ejection fraction (LVEF) for predicting mortality after infarction. BACKGROUND: HRV is an index of autonomic balance that identifies patients at a high risk of arrhythmic events. The index is most depressed during the first few weeks after myocardial infarction whereas left ventricular function tends to deteriorate with time. HYPOTHESIS: The value of depressed HRV measured before discharge from hospital for predicting mortality after infarction should decline with time. METHODS: The HRV and the LVEF were assessed in 433 survivors of a first acute myocardial infarction: HRV < 20 units and LVEF < 40% were taken as cut off points. Kaplan-Meier survival functions for total cardiac mortality and sudden cardiac death were calculated for the whole five year follow up period and for different intervening periods. RESULTS: During follow up of four weeks to five years there were 46 (10.6%) deaths and 15 (3.5%) patients died suddenly. Within the whole follow up period, HRV < 20 units and LVEF < 40% were both strongly associated with total cardiac mortality (p < 0.0001), but HRV was an independent predictor of total cardiac mortality only during the first six months of follow up. There were no deaths predicted by HRV < 20 units after the first year of follow up whereas LVEF < 40% had a sensitivity of 43% and a positive predictive accuracy of 9% for predicting death during this period. HRV < 20 units was better than LVEF < 40% in predicting sudden deaths during the first year of follow up but was an independent predictor only of those sudden deaths occurring within six months of infarction. CONCLUSIONS: The duration of follow up affects the prediction of sudden death and total cardiac mortality from HRV. Reduced HRV as measured before discharge from hospital does not seem to retain independent prognostic value after six months of follow up. These findings have potential implications for the serial evaluation of HRV and for the prevention of sudden death after myocardial infarction.

Death, Sudden, Cardiac↗
PubMed2004

Effect of doxorubicin plus cyclophosphamide on left ventricular ejection fraction in patients with breast cancer in the North Central Cancer Treatment Group N9831 Intergroup Adjuvant Trial.

PURPOSE: To evaluate changes in left ventricular ejection fraction (LVEF) after four cycles of adjuvant doxorubicin plus cyclophosphamide (AC) in women with human epidermal growth factor receptor 2-positive (node-positive or node-negative) breast cancer enrolled onto the North Central Cancer Treatment Group N9831 Intergroup Adjuvant Trial. PATIENTS AND METHODS: Patients were randomly assigned to receive standard doxorubicin (60 mg/m2) plus cyclophosphamide (600 mg/m2) every 3 weeks for four cycles followed by (1) weekly paclitaxel for 12 weeks; (2) weekly paclitaxel for 12 weeks, then weekly trastuzumab for 52 weeks; or (3) weekly paclitaxel plus trastuzumab for 12 weeks, then weekly trastuzumab for 40 weeks. LVEF was monitored before and after AC. RESULTS: Of the 1,576 eligible patients who completed AC, 1,458 had pre- and post-AC LVEF measurements taken using the same methodology (multiple-gated acquisition in 1,153 patients and echocardiogram in 305 patients). Among these 1,458 patients, 745 (51.1%) had < or = 15% decrease in LVEF and LVEF that remained at or above the radiologic lower limit of normal (LLN); 42 patients (2.9%) had < or = 15% decrease in LVEF and LVEF that decreased to or below the LLN; and 37 patients (2.5%) had an LVEF decrease of more than 15%. There was grade 2 LVEF toxicity in 96 (6.6%) of the 1,458 patients. CONCLUSION: Standard AC chemotherapy is associated with frequent decreases in LVEF, which are noted when measured 3 weeks after completion of the fourth cycle. Patients are being observed to determine the long-term significance of this and the potential impact on subsequent treatment options.

Adolescent↗
PubMed2006

MDCT of right ventricular function: impact of methodologic approach in estimation of right ventricular ejection fraction, part 2.

OBJECTIVE: The purpose of this study was to evaluate the impact of the methodologic approach for MDCT estimation of right ventricular ejection fraction (RVEF). MATERIALS AND METHODS: In 49 consecutive patients (30 men, 19 women; mean age, 59 years) known to have or suspected of having right ventricular (RV) dysfunction secondary to pulmonary disease, 16-MDCT of the heart was performed after standard CT angiographic examination of the entire thorax, with determination of RVEF by two reviewers who had limited experience in cardiac CT. The reconstruction windows were determined using the ECG tracing (reviewer 1) or using transverse test images obtained in 5% steps through the entire R-R interval showing the largest and smallest RV cavity areas (reviewer 2). After manual segmentation of the ventricular cavity on diastolic and systolic short-axis reformations by each reviewer, the end-diastolic and end-systolic RV volumes were calculated, with subsequent determination of the RVEF. CT results were compared with those of equilibrium radionuclide ventriculography. RESULTS: Agreement between the two methods for determining the end-systolic and end-diastolic phases was observed in 61% of cases (n = 30) for the systole and 59% of cases (n = 29) for the diastole. Discordant selections were observed in 39% of cases (n = 19) for determination of the systole and in 41% of cases (n = 20) for determination of the diastole, ranging from 5% to 15% of the R-R interval, suggesting that selection of the reconstruction window on the ECG tracing does not differ significantly from that obtained by the visual analysis of transverse test images. Focusing on the 59 common selections of the reconstruction windows made by the two reviewers, no statistically significant differences were found in the determination of mean (+/- SD) end-diastolic volumes (reviewer 1, 176.21 +/- 67 mL vs reviewer 2, 175.55 +/- 71.24 mL; p = 0.98) and end-systolic (reviewer 1, 97.3 +/- 26.49 mL vs reviewer 2, 96.33 +/- 65.72 mL; p = 0.65), suggesting the lack of operator dependence in the manual-contour drawing process. No significant difference was found between the mean values of RVEF obtained by each reviewer with MDCT and equilibrium radionuclide ventriculography, and there was excellent interobserver agreement with MDCT (intraclass correlation coefficient, 0.86). Using a Bland-Altman approach, the limits of concordance between the two reviewers ranged between -10.2 and 10.9. The mean absolute percentage error for measuring RVEF between the two reviewers was 9.7%. A moderate agreement was found between RVEFs obtained on CT by each reviewer and scintigraphy (intraclass correlation coefficients, 0.76 for reviewer 1 and 0.64 for reviewer 2). CONCLUSION: These results show that RVEF can be accurately assessed with ECG-gated MDCT using commercially available software.

Adult↗
PubMed2003

A new tool for estimating left ventricular ejection fraction derived from wall motion score index.

BACKGROUND: Radionuclide angiography (RNA) and echocardiography (biplane Simpson method) are the most accepted techniques for left ventricular ejection fraction (LVEF) assessment. A new method to evaluate LVEF based on the regional wall motion assessment of the LV was attempted. OBJECTIVE: To develop a simple method for LVEF estimation using wall motion score index (WMSI) with transthoracic echocardiography (TTE). METHODS: Two hundred and forty-three patients with abnormal LV contractility had TTE and RNA performed less than three days apart. The WMSI was calculated in all patients using the 16-segment model as proposed by the American Society of Echocardiography. For the first 150 patients, a correlation between LV WMSI and RNA EF was established to create a regression equation. This regression equation (RNA LVEF=92.8-25.8xWMSI) was used on 93 consecutive patients to compare this equation with RNA EF. From the total cohort (243 patients), three subgroups were studied specifically: atrial fibrillation (AF) (n=50 patients), dyskinesia (DK) (n=40 patients) and aneurysm (AN) (n=42 patients). RESULTS: Correlation between RNA EF and WMSI in the first 150 patients was r=0.82. In the second group of 93 consecutive patients, WMSI EF derived from the estimated regression equation correlated well with RNA EF (r=0.86). Correlation remained high in the three subgroups: AF (r=0.87), DK (r=0.87) and AN (r=0.80). In the 111 patients without DK, AN or AF correlation between RNA and the studied method was even higher (r=0.91). In a random subgroup of 54 patients, RNA was compared with the biplane Simpson method (49 of 54 patients, r=0.82). In the same subgroup of 54 patients, the score was modified to allow for mild hypokinesia (score=1.5) and severe hypokinesia (score=2.5) (54 of 54 patients, r=0.83). CONCLUSION: LVEF assessment by this new simple mathematical model using the WMSI is feasible and easy to use during routine TTE. It has excellent correlation with other methods such as biplane Simpson and RNA.

Adult↗
PubMed1989

[Significance of "overshoot" elevation of ejection fraction in early recovery period after exercise in patients with coronary artery disease].

To investigate the relationship between "overshoot" elevation of left ventricular (LV) ejection fraction (EF) in the early recovery period after exercise and myocardial ischemia, LV function was measured in 5 healthy volunteers and 47 pts with coronary artery disease (CAD) using supine ergometer. EF at rest (EFRE), at peak exercise (EFEX), at peak of overshoot (EFOS) and time from cessation of exercise to peak of overshoot (T-OS) were measured using an ambulatory LV function monitor system with a high sensitive CdTe detector. The patients were classified into 3 groups according to EF depression (EFRE-EFEX) by exercise, i.e., D1 (EF decreases less than 5%): 15 pts, D2 (EF decreases 5-10%): 12 pts, D3 (EF decreases greater than or equal to 10%): 20 pts. Degree of overshoot which shows difference in EF between rest and peak of overshoot was 23.8 +/- 2.13% (mean +/- SD) in the normal group, 11.72 +/- 5.12% in D1, 9.56 +/- 6.51 in D2 and 6.12 +/- 4.15% in D3, respectively. T-OS was 1.4 +/- 0.48 in the normal group, 2.8 +/- 0.54 in D1, 4.5 +/- 2.36 in D2 and 5.6 +/- 1.93 min in D3, respectively. We conclude that left ventricular dysfunction was proportionally related to time-lapse from cessation of exercise to peak of overshoot while inversely related to degree of overshoot.

Adult↗