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Reproducibility of radionuclide left ventricular ejection fraction in patients awaiting cardiac transplantation
A M Keogh1, S Eberl, M G Yeates
1Department of Cardiac Transplantation, St. Vincent's Hospital, Darlinghurst, Sydney, Australia.
Insights
Radionuclide left ventricular ejection fraction (LVEF) assessment shows lower reproducibility at very low levels in dilated cardiomyopathy patients. A change of 0.08 U is needed to confirm real changes in severe LV dysfunction.
Area of Science:
- Cardiology
- Nuclear Medicine
- Biomedical Imaging
Background:
- Left ventricular ejection fraction (LVEF) is crucial for assessing systolic function and managing dilated cardiomyopathy.
- Current methods for LVEF assessment lack reported reproducibility data at extremely low levels (<0.30).
Purpose of the Study:
- To evaluate the reproducibility of radionuclide-derived LVEF in patients with severe left ventricular dysfunction (LVEF < 0.30).
Main Methods:
- Seventeen symptomatic dilated cardiomyopathy patients (NYHA Class III/IV) underwent radionuclide LVEF scans twice, 72 hours apart.
- Two independent observers analyzed sequential scans to determine interobserver and interscan reproducibility.
Main Results:
- Mean LVEF was 0.18 ± 0.06 (scan 1) and 0.17 ± 0.06 (scan 2).
- Interobserver reproducibility (SD) was 0.03 U (R=0.76), interscan reproducibility (SD) was 0.03 U (R=0.62), and overall reproducibility (SD) was 0.04 U (R=0.50).
- Interobserver variation (0.027 U) was lower than in normal volunteers (0.05 U).
Conclusions:
- Radionuclide LVEF assessment demonstrates reduced reproducibility at levels below 0.30.
- A change of ≥0.08 U is recommended to indicate a real change in LV function for LVEF < 0.30.
- Clinicians must consider lower reproducibility when interpreting serial LVEF scans in severe LV dysfunction.
Abstract:
Radionuclide-derived left ventricular ejection fraction (LVEF) is used to assess LV systolic function, to follow trends in the natural history of dilated cardiomyopathy, and to prioritize patients waiting for cardiac transplantation. Reproducibility of LVEF at extremely low levels has not, however, been reported. To assess the reproducibility of radionuclide LVEF at levels below 0.30 EF U, 17 highly symptomatic patients (NYHA Class III/IV) with dilated cardiomyopathy were studied on two occasions, 72 hours apart. Sequential scans were analyzed by two independent observers. Mean LVEF was 0.18 +/- 0.06 U (scan 1) and 0.17 +/- 0.06 U (scan 2). Interoperator reproducibility (SD) was 0.03 U (R = 0.76), interscan reproducibility (SD) was 0.03 U (R = 0.62), and overall reproducibility (SD) was 0.04 U (R = 0.50). The interobserver variation of 0.03 (actually 0.027) was just over one half that seen in normal volunteers (variation 0.05, n = 29) studied previously in this department. A change of greater than or equal to 0.08 U (2SD) in either direction is highly likely to represent a real change in LV function in those with LVEF less than or equal to 0.30 units, compared with the change of at least 0.10 units required in those with normal LV function. Lower interobserver and interscan reproducibility should be taken into account when interpreting sequential scans in patients with severe LV dysfunction.