Subscribe to RSS
DOI: 10.4103/ajm.AJM_209_17
Visual versus fully automated assessment of left ventricular ejection fraction
Financial support and sponsorship Nil.
Abstract
Introduction: The aim of this study is to compare three different echocardiographic methods commonly used in the assessment of left ventricle (LV) ejection fraction (EF). Methods: All patients underwent full echocardiography including LVEF assessed using M-mode, automated EF (Auto-EF), and visual estimation by two readers. Results: We enrolled 268 patients. Auto-EF measurement was feasible in 240 (89.5%) patients. The averaged LVEF was (52% ± 12) with the visual assessment, (51% ± 11) with Auto-EF and (57% ± 13) with M-mode. Using Bland-Altman analysis, we found that the difference between the mean visual and the Auto-EF was not significant (−0.3% [−0.5803–0.0053], P = 0.054). However, the mean EF was significantly different when comparing visual versus M-mode and Auto-EF versus M-mode with the mean differences: (−2.4365 [−2.9946–−1.8783], P < 0.0001) and (−2.1490 [−2.7348–−1.5631], P < 0.0001) respectively. Inter-observer variability analysis of the visual EF assessment between the two readers showed that intraclass correlation coefficient was 0.953, (95% confidence interval: 0.939–0.965, P < 0.0001), with excellent correlation between the two readers: R = 0.911, P < 0.0001). Conclusion: The two-dimensional echocardiographic methods using Biplane Auto-EF or visual assessment were significantly comparable, whereas M-mode results in an overestimation of the LVEF.
Publication History
Article published online:
12 August 2021
© 2018. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
-
References
- 1 Wong M, Johnson G, Shabetai R, Hughes V, Bhat G, Lopez B. et al. Echocardiographic variables as prognostic indicators and therapeutic monitors in chronic congestive heart failure. Veterans Affairs cooperative studies V-HeFT I and II. V-HeFT VA Cooperative Studies Group. Circulation 1993; 87: VI65-70
- 2 Barbosa D, Heyde B, Dietenbeck T, Houle H, Friboulet D, Bernard O, Sarin YK. et al. Quantification of left ventricular volume and global function using a fast automated segmentation tool: Validation in a clinical setting. Int J Cardiovasc Imaging 2013; 29: 309-16
- 3 Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14.
- 4 Shahgaldi K, Gudmundsson P, Manouras A, Brodin LA, Winter R. Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography. Cardiovasc Ultrasound 2009; 7: 41
- 5 Frederiksen CA, Juhl-Olsen P, Hermansen JF, Andersen NH, Sloth E. et al. Clinical utility of semi-automated estimation of ejection fraction at the point-of-care. Heart Lung Vessel 2015; 7: 208-16
- 6 Akinboboye O, Sumner J, Gopal A, King D, Shen Z, Bardfeld P. et al. Visual estimation of ejection fraction by two-dimensional echocardiography: The learning curve. Clin Cardiol 1995; 18: 726-9
- 7 Lavine SJ, Salacata A. Visual quantitative estimation: Semiquantitative wall motion scoring and determination of ejection fraction. Echocardiography 2003; 20: 401-10
- 8 Thavendiranathan P, Popović ZB, Flamm SD, Dahiya A, Grimm RA, Marwick TH. et al. Improved interobserver variability and accuracy of echocardiographic visual left ventricular ejection fraction assessment through a self-directed learning program using cardiac magnetic resonance images. J Am Soc Echocardiogr 2013; 26: 1268-73
- 9 Gudmundsson P, Rydberg E, Winter R, Willenheimer R. Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol 2005; 101: 209-12
- 10 Rahmouni HW, Ky B, Plappert T, Duffy K, Wiegers SE, Ferrari VA. et al. Clinical utility of automated assessment of left ventricular ejection fraction using artificial intelligence-assisted border detection. Am Heart J 2008; 155: 562-70
- 11 Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072-83
- 12 Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr 2011; 24: 111-6
- 13 Cardim N, Fernandez GolfinC, Ferreira D, Aubele A, Toste J, Cobos MA. et al. Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination. J Am Soc Echocardiogr 2011; 24: 117-24
- 14 Kimura BJ, Gilcrease GW, Showalter BK, Phan JN, Wolfson T. Diagnostic performance of a pocket-sized ultrasound device for quick-look cardiac imaging. Am J Emerg Med 2012; 30: 32-6
- 15 Sinha S, Costa JA, Almeida ML, Estrada TC, Werneck GL, Rocha AM, Rosa ML. et al. Utility of ultraportable echocardiography in the preoperative evaluation of noncardiac surgery. Arq Bras Cardiol 2016; 107: 420-6
- 16 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG. et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Writing committee to update the 2001 guidelines for the evaluation and management of heart failure): Developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm society. Circulation 2005; 112: e154-235
- 17 Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM. et al. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997; 95: 2660-7
- 18 Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, Jadbabaie F. et al. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. J Am Coll Cardiol 2003; 42: 736-42
- 19 Cannesson M, Tanabe M, Suffoletto MS, McNamara DM, Madan S, Lacomis JM. et al. Anovel two-dimensional echocardiographic image analysis system using artificial intelligence-learned pattern recognition for rapid automated ejection fraction. J Am Coll Cardiol 2007; 49: 217-26
- 20 Knackstedt C, Bekkers SC, Schummers G, Schreckenberg M, Muraru D, Badano LP. et al. Fully automated versus standard tracking of left ventricular ejection fraction and longitudinal strain: The FAST-EFs multicenter study. J Am Coll Cardiol 2015; 66: 1456-66