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Comparison of techniques for the measurement of left ventricular function following cardiac transplantation
Nicholas G Bellenger1, Neil J Marcus, Kim Rajappan
1Cardiovascular MR Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK. nickbellenger@doctors.org.uk
Insights
Echocardiography and angiography overestimate left ventricular ejection fraction (LVEF) after heart transplant. Cardiovascular magnetic resonance and radionuclide ventriculography offer more reliable LVEF assessment for research.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Assessing cardiac allograft function is crucial for heart transplant recipients.
- Previous research indicates discrepancies in left ventricular ejection fraction (LV EF) measurements among different imaging modalities in heart failure patients.
Purpose of the Study:
- To compare the interchangeability of LV EF measurements using echocardiography (echo), angiography (angio), radionuclide ventriculography (RNV), and cardiovascular magnetic resonance (CMR) in heart transplant recipients.
- To identify the most reliable imaging technique for LV EF assessment in this population.
Main Methods:
- LV EF was assessed in 12 heart transplant patients one year post-transplant using echo, angio, RNV, and CMR.
- Scans were analyzed independently by blinded investigators.
Main Results:
- Mean LV EF varied significantly across techniques: RNV (63±6%), CMR (66±6%), angio (70±12%), and echo (74±4%).
- Poor correlations (r=0.3-0.6) and wide Bland-Altman limits of agreement (22-45%) were observed between methods.
- Echocardiography and angiography systematically overestimated LV EF and showed poor agreement with other techniques.
Conclusions:
- LV EF measurements by echo, angio, RNV, and CMR are not interchangeable in heart transplant patients.
- CMR and RNV demonstrated better agreement and are preferable for research studies.
- Echocardiography and angiography are less reliable for LV EF assessment in this cohort.
Background:
Assessment of graft function after cardiac transplantation is essential for patient management and clinical research. Previous studies have found that the left ventricular (LV) ejection fraction (EF) by echocardiography (echo), radionuclide ventriculography (RNV), and cardiovascular magnetic resonance (CMR) is discrepant in patients with heart failure.
Method:
Twelve patients underwent LV EF assessment by echo, angiography (angio), RNV, and CMR one year following heart transplantation. The scans were analyzed independently in blinded fashion.
Results:
The mean EF was 63 +/- 6% by RNV, 66 +/- 6% by CMR, 70 +/- 12% by angio, and 74 +/- 4% by echo. Significant differences were found between CMR and echo (p < 0.001), RNV and echo (p < 0.001), and RNV and angio (p < 0.05). The correlation between the techniques was poor (r = 0.3-0.6), and the scatter plots also suggested considerable variations between techniques. This was confirmed by the wide Bland-Altman limits of agreement (ranging from 22 to 45%). These were particularly wide for comparisons with angiography (43-45%).
Conclusion:
The EF measurement by echo, angio, RNV, and CMR are not interchangeable in patients following heart transplantation. The CMR and RNV provided the best agreement in EF and appear preferable for research studies. Echocardiography systematically overestimated LV EF and showed poor agreement with other techniques. Angiography overestimated LV function, and its routine use did not add to information gained from noninvasive studies.