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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Contrast administration reduces interobserver variability in determination of left ventricular ejection fraction in

Sunil Nayyar1, Anthony Magalski, Taiyeb M Khumri

  • 1Mid America Heart Institute, Kansas City, Missouri, USA.

The American Journal of Cardiology
|October 10, 2006
PubMed

Insights

Echocardiographic contrast agents significantly reduce variability in left ventricular ejection fraction (LVEF) assessments between doctors. Routine use of these agents improves the accuracy of LVEF measurements, especially for patients with moderate LV dysfunction.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Echocardiography

Background:

  • Accurate left ventricular ejection fraction (LVEF) assessment is crucial for heart failure management.
  • Existing echocardiographic methods can have significant interobserver variability.
  • Contrast agents are known to improve image quality.

Purpose of the Study:

  • To evaluate if routine echocardiographic contrast enhancement reduces interobserver variability in LVEF determination.
  • To compare the variability of LVEF measurements using different noncontrast and contrast-enhanced techniques.

Main Methods:

  • A cohort of patients with left ventricular dysfunction underwent baseline noncontrast echocardiography followed by contrast-enhanced imaging.
  • Two blinded echocardiographers assessed LVEFs using four methods: noncontrast estimated (NCE), noncontrast calculated (NCC), contrast estimated (CE), and contrast calculated (CC).
  • Interobserver variability was quantified using interclass correlation and standardized percentage differences.

Main Results:

  • Contrast calculated (CC) method showed the smallest proportion of variation due to the reader (0.11) compared to NCE (0.21), CE (0.25), and NCC (0.33).
  • This reduction in variability was consistent even when analyzing patients with LVEFs between 20% and 50%.
  • The mean standardized percentage difference between readers was minimal with the CC method.

Conclusions:

  • Echocardiographic contrast administration effectively reduces interobserver variability in LVEF assessment.
  • Routine use of contrast agents is recommended for LVEF measurement, irrespective of baseline image quality.
  • This is particularly important for patients with LVEFs between 20% and 50% to ensure reliable functional assessment.

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