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Quantitative echocardiographic analysis of global and regional left ventricular function: a problem revisited
P E Assmann1, C J Slager, S G van der Borden
1Department of Clinical Echocardiography, Thoraxcenter, Erasmus University, The Netherlands.
Summary
End-expiratory echocardiography significantly reduces measurement variability in left ventricular ejection fraction analysis compared to inspiratory measurements. This improved accuracy aids in assessing heart function, especially after myocardial infarction.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Cardiac Function Analysis
Background:
- Two-dimensional echocardiography is a key tool for assessing left ventricular function.
- Respiratory variations can introduce significant measurement variability in echocardiographic analysis.
- Accurate assessment of ejection fraction is crucial for diagnosing and managing cardiovascular conditions, including myocardial infarction.
Purpose of the Study:
- To quantitatively assess measurement variability in global and regional ejection fraction using two-dimensional echocardiography.
- To compare measurement variability during inspiration versus end-expiration.
- To evaluate the effectiveness of an improved computer-assisted tracing system in minimizing variability.
Main Methods:
- Simultaneous recording of two-dimensional echocardiograms and respiration in 20 normal subjects and 20 patients with anterior myocardial infarction.
- Quantitative analysis of apical long-axis and four-chamber views.
- Measurement variability calculation for global and regional ejection fraction (100 regions) during inspiration and end-expiration, with redefined endocardial contour tracing using a computer-assisted system.
Main Results:
- End-expiratory measurements showed significantly lower variability than inspiratory measurements for both global ejection fraction (3.4% vs. 6.4%) and regional ejection fraction (11.8% vs. 21.5%).
- Intraobserver and interobserver variability at end-expiration were low for ejection fraction (3.1% and 3.8%) and regional ejection fraction (9.5% and 12.8%).
- Variability in patients with myocardial infarction was comparable to normal subjects.
Conclusions:
- Recording respiration and analyzing left ventricular function at end-expiration, combined with an improved contour definition and tracing system, significantly reduces measurement variability.
- This optimized echocardiographic method achieves measurement variability comparable to traditional angiographic methods.
- The findings support the use of end-expiratory echocardiography for more reliable assessment of cardiac function, particularly in patients with myocardial infarction.