Assessment of left ventricular ejection fraction after myocardial infarction using contrast echocardiography
Tjebbe W Galema1, Marcel L Geleijnse, Sing-Chien Yap
1Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. t.w.galema@erasmusmc.nl
Insights
Adding echocardiography contrast agents significantly reduces variability in left ventricular ejection fraction (LV-EF) measurements. This improvement enhances the reliability of LV-EF assessment, even with lower-quality echocardiograms.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Ultrasound
Background:
- Echocardiography is the primary method for assessing left ventricular ejection fraction (LV-EF).
- High intra- and inter-observer variability in echocardiographic LV-EF measurements poses a clinical challenge.
- Second-generation microbubble contrast agents offer potential to improve echocardiographic accuracy.
Purpose of the Study:
- To evaluate the impact of second-generation microbubble contrast agents on the variability of LV-EF measurements.
- To determine if contrast-enhanced echocardiography can reduce observer-dependent errors in LV-EF assessment.
Main Methods:
- Forty-eight patients post-acute myocardial infarction underwent transthoracic echocardiography with and without contrast.
- LV-EF was calculated using the Simpson's biplane method in second-harmonic imaging mode.
- Intra- and inter-observer variability were assessed using Bland-Altman analysis.
Main Results:
- Contrast administration significantly reduced intra-observer variability from 12.5% to 7.0% (P < 0.001).
- Inter-observer variability decreased from 16.9% to 7.0% (P < 0.001) with contrast use.
- Improved variability was consistent across patients with varying echocardiogram quality.
Conclusions:
- Echocardiography contrast agents substantially enhance the consistency of LV-EF measurements.
- Contrast enhancement improves both intra- and inter-observer reliability for LV-EF assessment.
- The benefits of contrast agents are evident regardless of initial echocardiogram image quality.
Aims:
Despite its relatively high intra- and inter-observer variability for left ventricular ejection fraction (LV-EF) echocardiography is clinically still the most used modality to assess LV-EF. We studied whether adding a second-generation microbubble contrast agent could decrease this variability.
Methods And Results:
Forty-eight patients underwent transthoracic echocardiography in second-harmonic mode (SHI) with and without contrast within 5 days after an acute myocardial infarction. LV-EF was determined using the Simpson's biplane method. With contrast intra-observer variability decreased from 12.5 +/- 11.5% to 7.0 +/- 7.0% (P < 0.001) and inter-observer variability decreased from 16.9 +/- 9.9% to 7.0 +/- 6.2% (P < 0.001). Bland-Altman analysis confirmed these findings by demonstrating smaller 95% limits of agreement for both the intra- and inter-observer variability when contrast was used. This improvement in intra- and inter-observer variability was seen to a comparable extent in patients with moderate-to-poor and good quality SHI echocardiograms.
Conclusion:
Echo contrast significantly improves intra- and inter-observer variability for LV-EF, both in patients with moderate-to-poor and good quality SHI echocardiograms.
Related Concept Videos
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
01:30Acute Coronary Syndrome III: Diagnostic Studies