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Updated: Aug 14, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Sensitivity and specificity of left ventricular ejection fraction by echocardiographic automated border detection:
R J Lucariello1, Y Sun, G Doganay
1Department of Cardiology, Our Lady of Mercy University Hospital, Bronx, NY 10466, USA.
Insights
Automated border detection (ABD) for left ventricular ejection fraction (EF) shows moderate correlation but requires threshold adjustment for accurate clinical diagnosis of LV dysfunction. Optimized ABD-EF achieved 89% sensitivity and specificity.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Automated border detection (ABD) offers real-time, beat-to-beat estimation of left ventricular ejection fraction (LV EF).
- The clinical utility of ABD-EF for diagnosing left ventricular (LV) dysfunction, specifically its sensitivity and specificity, remains understudied in routine practice.
Purpose of the Study:
- To evaluate the sensitivity and specificity of ABD-EF for diagnosing LV dysfunction using receiver operating characteristic (ROC) analysis.
- To provide data on the clinical diagnostic performance of automated border detection in echocardiography.
Main Methods:
- Fifty consecutive patients underwent simultaneous LV EF measurement using ABD and radionuclide ventriculography (RVG).
- ABD-EF was recorded over 25 consecutive heartbeats in the apical four-chamber view.
- Statistical analyses included linear regression, Bland-Altman plots, and ROC analysis, with abnormal LV function defined as RVG-EF ≤ 40%.
Main Results:
- A moderate correlation (r=0.79) was observed between ABD-EF and RVG-EF.
- Averaging 25 beats reduced the standard error of estimate for ABD-EF from 15.6% to 12.5%, mitigating interbeat variability.
- After adjusting the threshold to 56% to correct for systematic overestimation, ABD-EF demonstrated 89% sensitivity and 89% specificity (85% overall accuracy) for detecting abnormal LV function.
Conclusions:
- On-line echocardiographic EF measurement using ABD has limitations in a clinical setting.
- This study provides crucial data on interbeat variability, sensitivity, and specificity for ABD-EF.
- Optimized thresholding is necessary for reliable clinical diagnosis of LV dysfunction using ABD-EF.
Background:
Echocardiographic automated border detection (ABD) provides on-line, beat-to-beat estimation of left ventricular (LV) ejection fraction (EF). Sensitivity and specificity of using ABD-EF for diagnosing LV dysfunction in routine clinical situations have not been previously studied.
Hypothesis:
Analysis of ABD-EF data based on receiver operating characteristic (ROC) should provide useful information about sensitivity and specificity for clinical diagnosis of LV function based on ABD-EF.
Methods:
The study group included 50 consecutive patients with EF measured by both ABD and radionuclide ventriculography (RVG). ABD-EF was recorded for 25 consecutive heart beats in the apical four-chamber view. Data were analyzed statistically by linear regression, Bland-Altman plot, and ROC. In ROC analysis, abnormal LV function was defined RVG-EF < or = 40%.
Results:
ABD and RVG showed a moderate correlation in the EF measurements: slope = 0.93, intercept = 17%, r = 0.79 (n = 50). Interbeat variability in ABD was diminished by averaging consecutive beats; standard error of estimate (SEE) decreased from 15.6% without averaging to 12.5% with 25-beat averaging. Bland-Altman analysis indicated that ABD-EF compared unfavorably with RVG-EF, with limits of agreement from -11% to 39%. ABD-EF showed a systematic overestimation (p < 0.005), which was compensated by increasing the threshold for abnormal ABD-EF to 56%. With the optimized threshold, ABD-EF provided 89% sensitivity and 89% specificity (85% overall diagnostic accuracy) for diagnosing abnormal LV function.
Conclusion:
This study explored the limitations of on-line echocardiographic measurement of EF in a clinical setting and provided useful data for assessing interbeat variability, sensitivity, and specificity.
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