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Published on: February 14, 2017
Accuracy and feasibility of simplified Doppler-based left ventricular ejection fraction
Vittorio Palmieri1, Fiorenzo Manganelli, Cesare Russo
1Unit of Cardiovascular Imaging, Cardiology, Azienda Ospedaliera San G. Moscati di Rilevanza Nazionale e di Alta Specialità, Avellino, Italy. vpalmieri68@gmail.com
Doppler-based left ventricular ejection fraction (EF) calculation can be accurate and feasible, even with heart wall motion abnormalities. A novel MRI-derived equation improves accuracy when estimating end-diastolic volume (EDV) from left ventricular internal diastolic diameter (LVIDD).
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Accurate calculation of left ventricular (LV) ejection fraction (EF) is crucial for diagnosing and managing heart conditions.
- Traditional methods for estimating LV volumes from LV internal diastolic diameter (LVIDD) using formulas like Teichholz and Z method may lack precision.
- Real-time 3-dimensional (RT3D) echocardiography and magnetic resonance imaging (MRI) offer advanced volumetric assessment but can be resource-intensive.
Purpose of the Study:
- To evaluate the accuracy of common formulas (Teichholz and Z method) for estimating LV end-diastolic volume (EDV) from LVIDD using MRI.
- To assess the accuracy and feasibility of simplified Doppler-echocardiography-derived EF compared to volumetric methods (RT3D echo, Simpson's method).
- To develop and validate a new equation for EDV estimation from LVIDD using MRI data and test its performance in echocardiography.
Main Methods:
- Magnetic resonance imaging (MRI) was used to assess accuracy of EDV estimation from LVIDD using Teichholz (EDVTeich) and Z methods versus volumetric EDV.
- A novel quadratic equation to estimate EDV from LVIDD was derived from MRI data.
- Simplified Doppler-EF was compared with RT3D echocardiography and bidimensional Simpson's method in a separate cohort.
- Feasibility of Doppler-EF and Simpson's method was assessed in a clinical sample.
Main Results:
- In MRI analysis, EDVTeich overestimated and EDVZ underestimated volumetric EDV (p <0.01). The novel quadratic equation showed high accuracy (R² = 0.97).
- In echocardiography, EDVTeich and Simpson's method EDV differed from RT3D EDV (p <0.05). Doppler-EF using EDVTeich was lower than RT3D-EF or Simpson's EF (p <0.01).
- Doppler-EF calculated with the novel MRI-derived EDV equation showed no significant difference compared to RT3D-EF.
- Doppler-EF feasibility was 95%, significantly higher than 72% for Simpson's method.
Conclusions:
- The choice of equation for estimating EDV from LVIDD significantly impacts the accuracy of simplified Doppler-EF.
- A novel MRI-derived equation enhances the accuracy of Doppler-based EDV estimation.
- Doppler-echocardiography-derived EF can be accurate and feasible, even in patients with LV contractile asynergy (wall motion abnormalities).
