Evaluation of left ventricular volumes and ejection fraction with a nonfluoroscopic endoventricular three-dimensional mapping technique

Background Recently, a novel nonfluoroscopic 3-dimensional electromechanica l mapping technique was introduced in the clinical arena. Although initial in vitro and in vivo studies suggested the reliability of the system in vol umetric and hemodynamic evaluation of the left ventricle, no validation in human beings has been performed. Methods A nonfluoroscopic electromechanical mapping (NOGA, Biosense-Webster ) procedure was performed in 44 patients. All patients received a contrast left ventriculogram during the some session. Volumetric (endcliastolic [EDV ] and end-systolic volumes [ESV]) and hemodynamic (left ventricular ejectio n fraction [LVEF] and stroke volume) parameters of both systems were compar ed. Results Two uncomplicated pericardial effusions occurred with the first-gen eration mapping catheters. No procedural complications were noted with the new-generation mapping catheters. Significant correlations were found betwe en mapping-derived and ventriculography-based measurements for both ESV (r = 0.67, P < .001) and LVEF (r = 0.78, P < .001). Absolute volumes, however, were only comparable for ESV (46.6 +/- 25.3 mi vs 48.8 +/- 37.0 mi, respec tively; P = .13) but differed greatly for LVEF (35% +/- 13% vs 65% +/- 19%, respectively; P < .001), EDV (69.1 +/- 28.6 mL vs 125.9 +/- 53.4 mL, respe ctively; P < .001) and stroke volume (22.4 +/- 9.9 mL vs 77. 1 +/- 33.7 res pirations; P < .001). Moreover, Bland-Airman analysis showed the clinical n oninterchangeability between these techniques for the measurement of hemody namic parameters. Conclusion Measurement of hemodynamic parameters with nonfluoroscopic mappi ng of the left ventricle is feasible and safe. The system provides data tha t strongly correlate but that are in clinical disagreement with angiographi c data. Therefore the interchangeability of these techniques may be questio ned.