ECHOCARDIOGRAPHY
Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography
A comparison with magnetic resonance imaging
Siri Malm, MD*,*,
Sigmund Frigstad, MSc ,
Einar Sagberg ,
Henrik Larsson, MD, PhD* and
Terje Skjaerpe, MD, PhD*
* Department of Circulation and Medical Imaging
Medical Student, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
GE Vingmed Ultrasound, Trondheim, Norway
Manuscript received January 17, 2004;
revised manuscript received May 6, 2004,
accepted May 10, 2004.
* Reprint requests and correspondence: Dr. Siri Malm, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, N-7489 Trondheim, Norway (Email: siri.malm{at}medisin.ntnu.no).
OBJECTIVES: We evaluated the accuracy and reproducibility of contrast echocardiography versus tissue harmonic imaging for measurements of left ventricular (LV) volumes and ejection fraction (EF) compared to magnetic resonance imaging (MRI).
METHODS: Digital echo recordings of apical LV views before and after intravenous contrast were collected from 110 consecutive patients. Magnetic resonance imaging of multiple short-axis LV sections was performed with a 1.5-T scanner. Left ventricular volumes and EF were calculated offline by method of discs. Thirty randomly selected patients were reanalyzed for intraobserver and interobserver variability.
RESULTS: Compared with baseline, contrast echo increased feasibility for single-plane and biplane volume analysis from 87% to 100% and from 79% to 95%, respectively. The Bland-Altman analysis demonstrated volume underestimation by echo, but much less pronounced with contrast. Limits of agreement between echo and MRI narrowed significantly with contrast: from –18.1% to 8.3% to –7.7% to 4.1% (EF), from –98.2 to –11.7 ml to –59.0 to 10.7 ml (end-diastolic volume), and from –58.8 to 21.8 ml to –38.6 to 23.9 ml (end-systolic volume). Ejection fraction from precontrast echo and MRI differed by  10% (EF units) in 23 patients versus 0 after contrast (p < 0.001). At intraobserver and interobserver analysis, limits of agreement for EF narrowed significantly with contrast.
CONCLUSIONS: The two-dimensional echocardiographic evaluation of LV volumes and EF in non-selected cardiac patients was found to be more accurate and reproducible when adding an intravenous contrast agent.
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Abbreviations and Acronyms
| | APLAX = apical long-axis | | ASE = American Society of Echocardiography | | EDV = end-diastolic volume | | EF = ejection fraction | | ESV = end-systolic volume | | LV = left ventricle | | LVO = left ventricular opacification | | MRI = magnetic resonance imaging | | 2CH = two-chamber | | 2D-echo = two-dimensional echocardiography | | 4CH = four-chamber |
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