Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance - Are they interchangeable?

Aims To prospectively compare the agreement of left ventricular volumes and ejection fraction by M-mode echocardiography (echo), 2D echo, radionuclide ventriculography and cardiovascular magnetic resonance performed in patien ts with chronic stable heart failure. It is important to know whether the r esults of each technique are interchangable, and thereby how the results of large studies in heart failure utilizing one technique can be applied usin g another. Some studies have compared cardiovascular magnetic resonance wit h echo or radionuclude ventriculography but few contain patients with heart failure and none have compared these techniques with the current fast brea th-hold acquisition cardiovascular magnetic resonance. Methods and Results Fifty two patients with chronic stable heart failure ta king part in the CHRISTMAS Study, underwent M-mode echo, 2D echo, radionucl ude ventriculography and cardiovascular magnetic resonance within 4 weeks. The scans were analysed independently in blinded fashion by a single invest igator at three core laboratories. Of the echocardiograms, 86% had sufficie nt image quality to obtain left ventricular ejection fraction by M-mode met hod, but only 69% by 2D Simpson's biplane analysis. All 52 patients tolerat ed the radionuclude ventriculography and cardiovascular magnetic resonance, and all these scans were analysable. The mean left ventricular ejection fr action by M-mode cube method was 39 +/- 16% and 29 +/- 15% by Teichholz M-m ode method. The mean left ventricular ejection fraction by 2D echo Simpson' s biplane was 31 +/- 10%, by radionuclude ventriculography was 24 +/- 9% an d by cardiovascular magnetic resonance was 30 +/- 11. All the mean left ven tricular ejection fractions by each technique were significantly different from all other techniques (P<0.001), except for cardiovascular magnetic res onance ejection fraction and 2D echo ejection fraction by Simpson's rule (P =0.23). The Bland-Altman limits of agreement encompassing four standard dev iations was widest for both cardiovascular magnetic resonance vs cube M-mod e echo and cardiovascular magnetic resonance vs Teichholz M-mode echo at 66 % each, and was 58% for radionuclude ventriculography vs cube M-mode echo, 44% for cardiovascular magnetic resonance vs Simpson's 2D echo, 39% for rad ionuclide ventriculography vs Simpson's 2D echo, and smallest at 31% for ca rdiovascular magnetic resonance-radionuclide ventriculography. Similarly, t he end-diastolic volume and end-systolic volume by 2D echo and cardiovascul ar magnetic resonance revealed wide limits of agreement (52 ml to 216 ml an d 11 ml to 188 ml, respectively). Conclusion These results suggest that ejection fraction measurements by var ious techniques are not interchangeable. The conclusions and recommendation s of research studies in heart failure should therefore be interpreted in t he context of locally available techniques. In addition, there are very wid e variances in volumes and ejection fraction between techniques, which are most marked in comparisons using echocardiography. This suggests that cardi ovascular magnetic resonance is the preferred technique for volume and ejec tion fraction estimation in heart failure patients, because of its 3D appro ach for non-symmetric ventricles and superior image quality. (C) 2000 The E uropean Society of Cardiology.