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European Heart Journal Advance Access originally published online on December 17, 2004
European Heart Journal 2005 26(6):607-616; doi:10.1093/eurheartj/ehi083
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© The European Society of Cardiology 2004. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography

Rainer Hoffmann1,*, Stephan von Bardeleben2, Folkert ten Cate3, Adrian C. Borges4, Jaroslaw Kasprzak5, Christian Firschke6, Stephane Lafitte7, Nidal Al-Saadi4, Stefanie Kuntz-Hehner8, Marc Engelhardt9, Harald Becher10 and Jean Louis Vanoverschelde11

1Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
2Clinic Johannes Gutenberg, University Mainz, Mainz, Germany
3Academic Hospital Dijkzigt, Rotterdam, The Netherlands
4University Charite, Berlin, Germany
5Medical University of Lodz, Bieganski Hospital, Lodz, Poland
6Deutsches Herzzentrum, Munich, Germany
7Hopital du Haut Leveque, Pessac Cedex, France
8University Bonn, Bonn, Germany
9Bracco Diagnostics Inc., Princeton, NJ, USA
10John Radcliffe Hospital, Oxford, UK
11Cliniques Universitaires Saint-Luc, Brussels, Belgium

Received 16 July 2004; revised 22 October 2004; accepted 18 November 2004; online publish-ahead-of-print 17 December 2004.

* Corresponding author: Tel: +49 2418088468; fax: +49 2418082303. E-mail address: rhoffmann{at}ukaachen.de

See page 534 for the editorial comment on this article (doi:10.1093/eurheartj/ehi142)

Aims To assess the agreement of left ventricular ejection fraction (LVEF) determinations from unenhanced echocardiography, contrast-enhanced echocardiography, magnetic resonance imaging (MRI), and cineventriculography as well as the inter-observer agreement for each method.

Methods and results In 120 patients, with evenly distributed EF-groups (>55, 35–55, <35%), cineventriculography, unenhanced echocardiography with second harmonic imaging, and contrast echocardiography at low mechanical index with iv administration of SonoVue® were performed. In addition, cardiac MRI at 1.5 T using a steady-state free precession sequence was performed in a subset of 55 patients. On-site, and two blinded off-site assessments were performed for unenhanced and contrast echocardiography, cineventriculography, and MRI according to pre-defined standards. Intra-class correlation coefficients (ICCs) were determined to assess inter-observer reliability between all three readers (i.e. one on-site and two off-site). EF was 56.2±18.3% by cineventriculography, 54.1±12.9% by MRI, 50.9±15.3% by unenhanced echocardiography, and 54.6±16.8% by contrast echocardiography. Correlation on EF between cineventriculography and echocardiography increased from 0.72 with unenhanced echocardiography to 0.83 with contrast echocardiography (P<0.05). Similarly, correlation on EF between MRI and echocardiography increased from 0.60 with unenhanced echocardiography to 0.77 with contrast echocardiography (P<0.05). The inter-observer reliability ICC was 0.91 (95% CI 0.88–0.94) in contrast echocardiography, followed by cardiac MRI (0.86; 95% CI 0.80–0.92), cineventriculography (0.80; 95% CI 0.74–0.85), and unenhanced echocardiography (0.79; 95% CI 0.74–0.85).

Conclusions Unenhanced echocardiography resulted in slight underestimation of EF and only moderate correlation compared with cineventriculography and MRI. Contrast echocardiography resulted in more accurate EF and significantly improved correlation with cineventriculography and MRI. Contrast echocardiography significantly improved inter-observer agreement on EF compared with unenhanced echocardiography. Inter-observer reliability on EF using contrast echocardiography reaches a level comparable to MRI and is better than those obtained by cineventriculography.

Key Words: Cineventriculography • Contrast echocardiography • Echocardiography • Left ventricular function • Magnetic resonance imaging


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