Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction: comparison with cine magnetic resonance imaging
W. Gregory Hundley, MD, FACC*  ,
Ali M. Kizilbash, MD*,
Imran Afridi, MD, FACC*,
Fatima Franco, MD*  ,
Ronald M. Peshock, MD, FACC* and
Paul A. Grayburn, MD, FACC*
* Department of Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Center, Dallas, Texas, USA
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Wake Forest University Medical Center, Winston-Salem, North Carolina, USA
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Figure 1 Transthoracic echocardiographic images of the apical four-chamber view obtained from a patient before (left) and after (right) the administration of contrast agent. The endocardial border is not well seen at baseline but becomes readily apparent with contrast enhancement.
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Figure 2 Regression plots showing the correlation between MRI (horizontal axis) and echocardiography (vertical axis) for LV end diastolic volumes (A), end systolic volumes (B) and EF (C). Data points for individual patients are displayed as precontrast values (black squares) or postcontrast values (black diamonds). Open symbols = patients in whom two or more segments were not seen on the precontrast echocardiogram.
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Figure 3 Bland–Altman plots showing the mean difference (solid lines) and the limits of agreement (dashed lines) between echocardiographic and MRI measurements of LV end diastolic volume (A and B), end systolic volume (C and D) and EF (E and F). Left = baseline echocardiography; right = postcontrast echocardiography. The value for each patient is represented by a diamond. For each variable the limits of agreement become more narrow after contrast agent administration.
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Figure 4 The percentage of subjects in which echocardiographic assessments of global LV systolic function were accurate for the determination of normal, mildly to moderately depressed or severely reduced LV systolic function. In subjects with complete visualization of the endocardium, contrast agent administration was of no benefit; however, if two or more endocardial segments were not visualized at baseline, contrast enhancement markedly improved classification of EF subsets. Open bars = standard echocardiography; solid bars = contrast echocardiography.
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