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Comparison of single and biplane ejection fractions in patients with Ischaemic heart disease
Insights
Assessing left ventricular performance in ischemic heart disease requires biplane ventriculography. Single-plane ejection fraction measurements often differ significantly, especially with myocardial infarction or wall motion abnormalities.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Ischemic heart disease (IHD) affects left ventricular (LV) function.
- Accurate assessment of LV ejection fraction (EF) is crucial for IHD patient management.
- Single-plane ventriculography may not fully capture LV performance due to complex wall motion.
Purpose of the Study:
- To compare frontal (EFF), lateral (EFL), and biplane (EFB) ejection fraction measurements.
- To evaluate the impact of transmural myocardial infarction and wall motion abnormalities on EF discrepancies.
- To determine the utility of biplane ventriculography for accurate LV performance assessment in IHD.
Main Methods:
- Simultaneous biplane left ventriculography in 59 IHD patients.
- Comparison of EFF, EFL, and EFB measurements.
- Patient stratification based on ECG/echocardiographic evidence of transmural myocardial infarction or wall motion abnormalities.
Main Results:
- Frequent discrepancies observed between single-plane (EFF, EFL) and biplane (EFB) EF measurements.
- EFL commonly exceeded EFF in patients with transmural myocardial infarction or wall motion abnormalities.
- Significant differences between single-plane and biplane EF were noted in patients with wall motion abnormalities.
- Close agreement between EFF and EFL was found in patients without these abnormalities.
Conclusions:
- Single-plane EF measurements can be unreliable in IHD patients, particularly those with transmural myocardial infarction or wall motion abnormalities.
- Biplane ventriculography provides a more accurate assessment of left ventricular performance in these patients.
- Simultaneous or sequential biplane ventriculography is recommended for precise evaluation of LV function in ischemic heart disease.
Abstract:
Simultaneous biplane left ventriculography was performed in 59 patients with ischaemic heart disease. A comparison was made of the frontal (EFF), lateral (EFL), and biplane (EFB) ejection fractions. Discrepancies between the three measurements in the same patient were frequent observed. The patients were then grouped according to the presence or absence of signs of transmural myocardial infarction in the electrocardiogram or wall motion abnormalities, and the single and biplane EF data were again compared. There were 31 patients with previous transmural myocardial infarction and 37 patients with wall motion abnormalities, usually involving the anterior or inferior walls. The EFL of patients with transmural myocardial infarction or wall motion abnormalities commonly exceeded the EEF, because of frequent preservation of dorsal wall contraction visualized only in the lateral plane. Consequently, there was a significant difference between EFF or EFL and EFB for these patients. In contrast, there was close agreement EEF and EFL for patients without transmural myocardial infarction or wall motion abnormalities. It is concluded that differences frequently occur between single and biplane EF in patients with ischaemic heart disease, especially if transmural myocardial infarction or wall motion abnormalities are present. Hence, accurate assessment of left ventricular performance is greatly facilitated by simultaneous or sequential biplane ventriculography.
