Accuracy and Feasibility of Simplified Doppler-Based Left Ventricular Ejection Fraction

• Published in: The American journal of cardiology Vol. 112; no. 6; pp. 889 - 894
• Main Authors: Palmieri, Vittorio, MD, PhD, Manganelli, Fiorenzo, MD, Russo, Cesare, MD, Gagliardi, Biagio, MD, Pezzullo, Salvatore, MD, Gagliardi, Giuliano, MD, Rosato, Giuseppe, MD, Lombardi, Carmelo, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-09-2013; Elsevier Limited
• Subjects: Accuracy; Cardiology; Cardiovascular; Clinical medicine; Echocardiography, Doppler - methods; Echocardiography, Three-Dimensional - methods; Feasibility Studies; Female; Geometry; Heart attacks; Humans; Male; Methods; Middle Aged; NMR; Nuclear magnetic resonance; Reproducibility of Results; Severity of Illness Index; Stroke Volume - physiology; Studies; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left - physiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.05.019

Calculation of left ventricular (LV) ejection fraction (EF) by Doppler stroke volume and end-diastolic volume (EDV) derived from LV diastolic diameter (LVIDD) could be reliable and feasible in clinical practice. In subjects with a wide range of LV volumes and EFs, magnetic resonance imaging (MRI) was used to evaluate the accuracy of common formulas (Teichholz and Z method) to estimate EDV from LVIDD (EDVTeich ; EDVZ ) versus volumetric EDV. The accuracy of simplified Doppler-EF was tested in a separate study sample versus real-time 3-dimensional (RT3D) echocardiography and versus bidimensional Simpson's method. A new equation to calculate EDV from LVIDD was derived using MRI and tested in the RT3D echo samples. Feasibility of Doppler-EF was tested in a third sample of consecutive inpatients and outpatients. In the MRI sample, EDVTeich was greater whereas EDVZ was smaller than volumetric EDV (both p <0.01); however, a quadratic equation estimated EDV from LVIDD with accuracy (R2  = 0.97). In the echocardiographic sample, independent of severe segmental wall motion abnormalities, EDVTeich was greater whereas EDV using Simpson's method was smaller than RT3D EDV (all p <0.05); Doppler-EF using EDVTeich was lower compared with EF by Simpson's rule or by RT3D-EF (all p <0.01). However, RT3D-EF showed no differences compared with Doppler-EF when EDV was calculated by the novel MRI-derived equation. Feasibility was 95% for Doppler-EF and 72% using Simpson's method. In conclusion, equations estimating EDV from LVIDD affect the accuracy of simplified Doppler-EF. However, Doppler-based EF may be accurate and feasible even in the presence of LV contractile asynergy.