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High intermodality variability in ejection fraction measured by echocardiography, cardiac magnetic resonance and single photon emission computed tomography in chronic coronary artery disease patients

Session Poster Session 1

Speaker Thomas Muri Stokke

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Imaging of Systolic and Diastolic Function
  • Session type : Poster Session

Authors : TM Stokke (Oslo,NO), SI Sarvari (Oslo,NO), AW Bjerring (Oslo,NO), KH Haugaa (Oslo,NO), MT Elahi (Leuven,BE), SI Hoedemakers (Leuven,BE), F Rademakers (Leuven,BE), M Monaghan (London,GB), R Sicari (Pisa,IT), J Engvall (Linkoping,SE), E Nagel (Frankfurt am Main,DE), JL Zamorano (Madrid,ES), H Ukkonen (Turku,FI), J D'hooge (Leuven,BE), T Edvardsen (Oslo,NO)

T.M. Stokke1 , S.I. Sarvari2 , A.W. Bjerring1 , K.H. Haugaa1 , M.T. Elahi3 , S.I. Hoedemakers3 , F. Rademakers4 , M. Monaghan5 , R. Sicari6 , J. Engvall7 , E. Nagel8 , J.L. Zamorano9 , H. Ukkonen10 , J. D'hooge3 , T. Edvardsen1 , 1Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital and University of Oslo - Oslo - Norway , 2Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital - Oslo - Norway , 3KU Leuven, Lab on Cardiovascular Imaging and Dynamics - Leuven - Belgium , 4University Hospitals (UZ) Leuven, Department of Cardiovascular Sciences and KU Leuven - Leuven - Belgium , 5Kings College Hospital, Department of Non-invasive Cardiology - London - United Kingdom , 6Institute of Clinical Physiology (IFC) - Pisa - Italy , 7Linkoping University, Department of Clinical Physiology and Department of Medical and Health Sciences - Linkoping - Sweden , 8University Hospital Frankfurt, Institute for Experimental and Translational Cardiovascular Imaging - Frankfurt am Main - Germany , 9University Hospital Ramon y Cajal de Madrid, Cardiovascular Imaging Unit - Madrid - Spain , 10Turku University Hospital, Department of Medicine - Turku - Finland ,

Imaging: Systolic and Diastolic Function

European Heart Journal ( 2019 ) 40 ( Supplement ), 217

Background: Clinical treatment strategies are often based on measurement of left ventricular ejection fraction (LVEF). There is limited evidence about variations in LVEF when measured by different imaging modalities.

Purpose: To investigate the intermodality variability of LVEF measured by two-dimensional echocardiography (2DE), three-dimensional echocardiography (3DE), cardiac magnetic resonance (CMR), and single photon emission computed tomography (SPECT) in patients with chronic coronary artery disease (CAD).

Methods: Patients from a multicenter study (DOPPLER-CIP – Determining optimal noninvasive parameters for the prediction of left ventricular remodeling in chronic ischemic patients) with chronic CAD were included. LVEF was measured by CMR and at least one additional modality. In each modality, LVEF was measured by a core laboratory independently of the other modalities. Measurements of LVEF by CMR were compared to 2DE, 3DE and SPECT using correlation and Bland-Altman plots.

Results: A total of 343 patients were included. Mean age was 63.9±8.3 years and 253 (74%) were males. Mean LVEF by CMR was 61.8±11.6%. Correlations between CMR LVEF and other modalities were moderate for 2DE and 3DE, and good for SPECT (Figure A-C). CMR had significantly greater correlation to SPECT, compared to 2DE and 3DE. Bland-Altman plots indicated relatively wide limits of agreement between all modalities, ranging from 31% to 42% (Figure, D-F). Mean absolute difference of LVEF between CMR and other modalities were 8.5% for 2DE, 9.0% for 3DE, and 8.3% for SPECT. The percentage of measurements that fell within a range of 5% difference compared to CMR LVEF was 41% for 2DE, 34% for 3DE and 37% for SPECT (all p>0.05).

Conclusions: In a multicenter study with chronic CAD patients, LVEF assessed by CMR had better correlation to SPECT, compared to 2DE and 3DE. However, there was considerable variability among all three modalities that were compared to CMR. Awareness of these variations are important in clinical management.

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