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The corrected left ventricular ejection fraction: a potential new measure of ventricular function.
Jonathan Carl Luis Rodrigues1,2, Benjamin Rooms3, Katie Hyde3
1NIHR Bristol Cardiovascular Biomedical Research Centre, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
The International Journal of Cardiovascular Imaging
|February 22, 2021
Summary
Left ventricular ejection fraction (LVEF) is limited in predicting heart disease outcomes. This study developed a corrected LVEF (EFc) using cardiac MRI, improving myocardial function assessment, especially in conditions with altered ventricular geometry.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Left ventricular ejection fraction (LVEF) is a standard but limited metric for assessing cardiac function and prognosis in heart diseases.
- Geometric factors and myocardial strain significantly influence LVEF, yet their independent contributions are not fully elucidated.
- Existing methods may misrepresent ventricular function in conditions with abnormal heart chamber dimensions and wall thickness.
Purpose of the Study:
- To mathematically model and quantify the independent geometric determinants of LVEF using cardiac MRI.
- To develop an adjusted LVEF (EFc) that accounts for variations in ventricular size and wall thickness.
- To enhance the assessment of myocardial performance, particularly in patients with hypertrophic or dilated cardiomyopathies.
Main Methods:
- Utilized a mathematical model to analyze the impact of structural variables and myocardial shortening on LVEF.
- Analyzed cardiac MRI data from 183 patients, including those with idiopathic dilated cardiomyopathy (DCM), amyloidosis, hypertension, and healthy controls.
- Measured left ventricular volumes, LVEF, wall thickness, internal dimensions, and longitudinal/midwall fractional shortening.
Main Results:
- LVEF demonstrated a curvilinear relationship with midwall fractional shortening, longitudinal shortening, and wall thickness, while decreasing with increased internal diameter.
- A regression equation derived from MRI data (R²=0.856) was used to calculate EFc by normalizing for ventricular size and wall thickness.
- The EFc reclassified ventricular function in some individuals, offering a potentially more accurate measure of myocardial performance, especially in ventricles with abnormal wall thickness and volume.
Conclusions:
- Independent geometric factors significantly influence LVEF, necessitating adjustments for accurate functional assessment.
- The corrected LVEF (EFc) provides a more refined measure of myocardial mechanics, particularly valuable in complex cardiac conditions.
- This approach improves the understanding of ventricular function beyond traditional LVEF, aiding in better patient stratification and management.
Keywords:
AmyloidCardiomyopathyEjection fractionHypertensionLeft ventricular hypertrophyMyocardial shorteningMyocardial strain
