Cardiology Letters 2020, 29(4):229-234

Exact classification of left ventricular function

Beňačka O¹, Horváth V¹, Hatala R², Goncalvesová E¹

¹ Kardiologická klinika Lekárská fakulta UK a Národný ústav srdcových a cievnych chorôb, a. s., Bratislava

² Kardiologická klinika Lekárská fakulta SZU a Národný ústav srdcových a cievnych chorôb, a. s., Bratislava, Slovenská republika

Introduction: Left ventricular ejection fraction (LVEF) is an important prognostic parameter and plays a role in indication of many cardiologic and cardiosurgery interventions. Despite a recommendation to assess LVEF by bi-plane Simpson's method, it is still very common to evaluate LVEF by visual estimation. Wrongly estimated LVEF can fundamentally change the clinical destiny of the patient.

Aims: To evaluate the dispersion of LVEF values assessed in a certain patient by nine experienced echocadiography examiners. A secondary aim was to evalute the proportion of patients in which the examiners were not able to sort into groups with LVEF > 35% or LVEF ≤ 35% respectively. Then compare this finding with a new cut-off point of LVEF 40%.

Methods: From each patient one complex videoloop was made containing all available echocardiographic projections. Subsequently these videoloops were sent to nine echocardiography examiners, who evaluated the LVEF visualy.

Results: 49 patients were examined. The average dispersion of LVEF values assessed by nine examiners in one patient was 23% ± 2 (95% CI). The consistency in grouping patients to a group with LVEF > 35 or LVEF ≤ 35% respectively was only in 56% of patients. In the remaining 44% there was no absolute consensus to which group they belonged. A similiar result was observed when the cut-off value was changed to LVEF 40%. However the difference was that in the LVEF 40% cut-off value this discrepancy was mainly due to one (but not always the same) examiner.

Conclusion: Visual estimation of LVEF leads to great inter-individual variability, which can radically change the therapeutic decisions. It seems that a simple clustering of the patients into a group of HFrEF (heart failure with reduced ejection fraction) or HFmrEF (heart failure with moderate reduced ejection fraction) is more coherent in the results.

Keywords: echocardiography; left ventricular ejection fraction; visual estimation

Published: April 1, 2020  Show citation