Lack of agreement between left ventricular volumes and ejection fraction determined by two-dimensional echocardiography and contrast cineangiography in postinfarction patients

Objective: To assess the agreement between left ventricular (LV) volumes an d ejection fraction (EF) determined by two-dimensional echocardiography (2- D echo) and by cineangiography in postinfarction patients. Design: LV end-d iastolic and end-systolic volumes indexed (EDVI and ESVI) to body surface a rea as well as EF were determined by both methods in all patients. Setting: Multicenter trial conducted in five university hospitals. Patients: 63 pat ients, 61 male, two female, mean age 55.5 +/- 10.4 years, suffering from a recent myocardial infarction. Eighty-one pairs of measurements were availab le. Methods: The results of biplane 2 D echo measures, using apical four-ch amber (4C) and two-chamber (2C) views were compared to those of a 30 degree s right anterior oblique cineangiography projection, using either the apica l method of discs or the area-length 2-D echo method. Moreover, eyeball EF was estimated at 2-D echo and cineangiography, and was compared to the conv entional methods. The agreement between results was assessed by the Bland a nd Altman, method. Results: The agreement between 2-D echo and cineangiogra phy results was poor. Mean differences (MD) were -21.8 EDVI, ml/m(2)), -9.5 (ESVI, ml/m(2)), and -0.9 (EF: %, respectively for 2-D echo method of disc s versus cineangiography, and -23.2, -9.3 and -5.7 for area-length 2-D echo versus cineangiography. For EF (%), MD was -3.6 for eyeball cineangiograph y versus cineangiography, -1.3 for eyeball 2-D echo versus method of discs, and +0.30 for eyeball 2 D echo versus area-length 2-D echo, respectively. Two-dimensional echo is likely to underestimate LV volumes compared to cine angiography, especially for Largest volumes. Even. for EF discrepancies are large, with a lack of agreement of 21%-25% between conventional methods, b ut agreement is better between eyeball EF and usual methods. Conclusions: E ven with modern echocardiographic devices, agreement between 2-D echo and c ineangiography-derived LV volumes and EF remains moderate, and both methods must not be considered interchangeable in, clinical practice.