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Cited by 238Cardiovascular Function and Risk FactorsCardiac Imaging and DiagnosticsCardiac pacing and defibrillation studies

Variability in Ejection Fraction Measured By Echocardiography, Gated Single-Photon Emission Computed Tomography, and Cardiac Magnetic Resonance in Patients With Coronary Artery Disease and Left Ventricular Dysfunction

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Pellikka, Patricia A., She, Lilin, Holly, Thomas A., Lin, Grace, Varadarajan, Padmini, Pai, Ramdas G., Bonow, Robert O., Pohost, Gerald M. +12 more·2018·JAMA Network Open
DOI 10.1001/jamanetworkopen.2018.1456PMC PMC6324278
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Abstract

Importance: Clinical decisions are frequently based on measurement of left ventricular ejection fraction (LVEF). Limited information exists regarding inconsistencies in LVEF measurements when determined by various imaging modalities and the potential impact of such variability. Objective: To determine the intermodality variability of LVEF measured by echocardiography, gated single-photon emission computed tomography (SPECT), and cardiovascular magnetic resonance (CMR) in patients with left ventricular dysfunction. Design, Setting, and Participants: International multicenter diagnostic study with LVEF imaging performed at 127 clinical sites in 26 countries from July 24, 2002, to May 5, 2007, and measured by core laboratories. Secondary study of clinical diagnostic measurements of LVEF in the Surgical Treatment for Ischemic Heart Failure (STICH), a randomized trial to identify the optimal treatment strategy for patients with LVEF of 35% or less and coronary artery disease. Data analysis was conducted from March 19, 2016, to May 29, 2018. Main Outcomes and Measures: At baseline, most patients had an echocardiogram and subsets of patients underwent SPECT and/or CMR. Left ventricular ejection fraction was measured by a core laboratory for each modality independent of the results of other modalities, and measurements were compared among imaging methods using correlation, Bland-Altman plots, and coverage probability methods. Association of LVEF by each method and death was assessed. Results: A total of 2032 patients (mean [SD] age, 60.9 [9.6] years; 1759 [86.6%] male) with baseline LVEF data were included. Correlation of LVEF between modalities was r = 0.601 (for biplane echocardiography and SPECT [n = 385]), r = 0.493 (for biplane echocardiography and CMR [n = 204]), and r = 0.660 (for CMR and SPECT [n = 134]). Bland-Altman plots showed only moderate agreement in LVEF measurements from all 3 core laboratories with no substantial overestimation or underestimation of LVEF by any modality. The percentage of observations that fell within a range of 5% ranged from 43% to 54% between different imaging modalities. Conclusions and Relevance: In this international multicenter study of patients with coronary artery disease and reduced LVEF, there was substantial variation between modalities in LVEF determination by core laboratories. This variability should be considered in clinical management and trial design. Trial Registration: Clinicaltrials.gov Identifier: NCT00023595.

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  • Echocardiography LVEF measurement is less precise relative to other approaches such as magnetic resonance imaging.

    “This might also be attributable to a lack of precision in LVEF measurement by echocardiography, which has shown to be less precise relative to other approaches, such as magnetic resonance imaging27,28.”

    From Detection of left ventricular systolic dysfunction from single-lead electrocardiography adapted for portable and wearable devices (2023) · cites this paper as [27]

    The Results (Comparison of Imaging Modalities; page unavailable) show greater disagreement between echocardiography and CMR than between CMR and SPECT, supporting a concern about variability in echocardiographic LVEF measurements. But the Discussion and Limitations say there is no gold standard and do not establish that echocardiography itself is less precise than CMR; the study primarily compares agreement between modalities. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Pellikka, P. A., She, L., Holly, T. A., Lin, G., Varadarajan, P., Pai, R. G., Bonow, R. O., Pohost, G. M., Panza, J. A., Berman, D. S., Prior, D. L., Asch, F. M., Borges-Neto, S., Grayburn, P., Al-Khalidi, H. R., Miszalski-Jamka, K., Desvigne-Nickens, P., Lee, K. L., Velazquez, E. J., & Oh, J. K.
Affiliations
  • Mayo Clinic (US)
  • Duke University (US)
  • Northwestern University (US)
  • Loma Linda University (US)
  • University of California, Riverside (US)
  • Westchester Medical Center (US)
  • Cedars-Sinai Medical Center (US)
  • The University of Melbourne (AU)
  • MedStar Washington Hospital Center (US)
  • Division of Nuclear Medicine, Department of Radiology, Duke University School of Medicine, Durham, North Carolina
  • Baylor University Medical Center (US)
  • Duke Clinical Research Institute, Durham, North Carolina
  • Division of Magnetic Resonance Imaging, Silesian Center for Heart Diseases, Zabrze, Poland
  • National Institutes of Health (US)
Corresponding author
Pellikka, Patricia A.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2018-08-31
Volume
1
Issue
4
Pages
e181456
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2018.1456
PMC
PMC6324278
OpenAlex
W2891975710
Cited by
238
References
2
Citations by year
2026: 34 · 2025: 31 · 2024: 22 · 2023: 34 · 2022: 33 · 2021: 37 · 2020: 24 · 2019: 19 · 2018: 4
FWCI
15.89
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Touro Scholar (Touro College) (submittedVersion, cc-by)
Funders
  • Amgen
  • Pfizer
  • Alnylam Pharmaceuticals
  • Edwards Lifesciences
  • Boston Scientific Corporation
  • Cedars-Sinai Medical Center
  • Abiomed
  • National Institutes of Health
  • Abbott Vascular
  • National Heart, Lung, and Blood Institute (U01 HL-69015, R01-HL10583, R01HL105853, U01HL069015, U01-HL69013, U01HL069013)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
left ventricular ejection fraction, intermodality agreement, echocardiography, gated SPECT, cardiovascular magnetic resonance, left ventricular dysfunction, coronary artery disease, ischemic heart failure, STICH trial, measurement variability, mortality prediction, heart failure risk stratification, heart failure with reduced ejection fraction, heart failure with preserved ejection fraction
MeSH terms
Coronary Artery Disease, Echocardiography, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Stroke Volume, Ventricular Dysfunction, Left, Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography, Cardiac Imaging Techniques

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