Related Experiment Videos
The discrepancy between echocardiography, cineventriculography and thermodilution. Evaluation of left ventricular
1First Department of Internal Medicine, Nagoya University School of Medicine, Japan.
Insights
Echocardiography and cineventriculography show disagreements in left ventricular volumes and ejection fraction due to patient anxiety and invasive procedure effects. Echocardiography offers high reproducibility and unique insights into cardiac function.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Discrepancies exist between echocardiography and cineventriculography for left ventricular volumes and ejection fraction.
- These differences may be influenced by patient anxiety and the stress of invasive procedures.
Purpose of the Study:
- To compare left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) using 2D echocardiography versus cineventriculography and thermodilution.
- To assess the reproducibility of echocardiography compared to invasive methods.
Main Methods:
- 65 patients underwent 2D echocardiography within three days of cardiac catheterization.
- Measurements of EDV, ESV, stroke volume, and EF were compared using echocardiography, thermodilution, and biplane cineventriculography.
Main Results:
- Significant differences in heart rate and stroke volume were observed, with cineventriculography yielding higher values.
- While correlations were good, agreement was lacking for EDV, ESV, and EF between methods.
- Echocardiographic EDV was lower than cineventriculographic EDV, suggesting hyperdynamic states during invasive procedures.
Conclusions:
- Patient anxiety and invasive procedures can induce hyperadrenergic or hypodynamic states, affecting cardiac measurements.
- Echocardiography is highly reproducible and provides valuable information not obtainable by other methods.
- Understanding the unique properties of each technique is crucial when interpreting cardiac conditions assessed by different methods on separate days.
Abstract:
We have often experienced disagreement in left ventricular end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) between cineventriculography and echocardiography not performed simultaneously, and unnaturally hyperdynamic left ventricular wall motion. We determined EDV, ESV, stroke volume, and EF (with modified Simpson's rule) in 65 consecutive patients using 2-dimensional echocardiography with a 2.5 MHz, 128-element phased-array transducer within three days of cardiac catheterization and compared our results with those obtained by the thermodilution technique and biplane cineventriculography. Heart rate and stroke volume were significantly different among the three techniques: cineventriculography yielded the highest values. These findings suggest that patients may have been in a hyperadrenergic state caused by anxiety experienced during invasive cineventriculography and thermodilution examinations. Inter- and intraobserver variabilities for echocardiography differed little from the variability in cineventriculography. Although there were good correlations between echocardiographic and cineventriculographic findings for EDV (r = 0.67), ESV (r = 0.80), and EF (r = 0.78) by two independent observers, there was a lack of agreement for EDV, ESV, and EF. Echocardiographic EDV values were significantly lower than cineventriculographic values. When left ventricular function is good, the left ventricle tends to be hyperadrenergic and in a more hyperdynamic state with smaller ESV than echocardiographic values during cineventriculography. When left ventricular function is poor, the left ventricle tends to be influenced by the effect of the contrast medium and stress during the invasive examinations and in a more hypodynamic state with larger ESV than echocardiographic values during cineventriculography. The echocardiography is highly reproducible and may provide information that is not available from cineventriculography and thermodilution. Cineventriculography may provide another manifestation of cardiac reserve. In conclusion, we must take into account each peculiar property of the echocardiography, the cineventriculography, or the thermodilution technique when patients are examined with cardiac conditions by different methods at different days.