Skip to main content
SpringerLink
Log in

5/6 Area Length Method for Left-Ventricular Ejection-Fraction Measurement in Adults with Repaired Tetralogy of Fallot: Comparison with Cardiovascular Magnetic Resonance

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

In patients with repaired tetralogy of Fallot (rTOF), left-ventricular ejection fraction (LVEF) predicts adverse outcomes. Two-dimensional echocardiographic (2DE) methods of measuring LVEF require geometric assumptions and may be limited in this population due to altered ventricular geometry. This study evaluated the performance of the 5/6 area × length (AL) method in this population as well as which factors limit agreement with the results of cardiovascular magnetic resonance (CMR). In 20 patients with rTOF (28.5 ± 14.7 years old) and CMR and 2DE within 3 months, two investigators blinded to CMR measured LVEF from 2DE by the AL method, biplane Simpson’s (BiS) method, and visual estimate. Two investigators blinded to 2DE measured LVEF from CMR by Simpson’s and AL methods. The AL method on 2DE more closely approximated LVEF by CMR (r = 0.73, p = 0.0003) than BiS method (r = 0.53, p = 0.02). AL method was not limited by geometric assumptions, as AL method on CMR closely approximated Simpson’s method on CMR (r = 0.90, p < 0.0001) despite median left-ventricular diastolic eccentricity index of 1.24. AL method on 2DE was primarily limited by short-axis area measurement rather than foreshortening of the ventricle. In conclusion, in adults with rTOF, AL method on 2DE moderately approximates LVEF by CMR, even in the context of altered left-ventricular geometry. Although the AL method may be the most appropriate 2DE method in this population, significant limitations remain for LVEF assessment by 2DE, and strategies to optimize image position and border detection are essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    Article  CAS  PubMed  Google Scholar 

  2. Chukwu E, Barasch E, Mihalatos D, Katz A, Lachmann J, Han J et al (2008) Relative importance of errors in left ventricular quantitation by two-dimensional echocardiography: insights from three-dimensional echocardiography and cardiac magnetic resonance imaging. J Am Soc Echocardiogr 21(9):990–997

    Article  PubMed  Google Scholar 

  3. Friedberg MK, Su X, Tworetzky W, Soriano BD, Powell AJ, Marx GR (2010) Validation of 3D echocardiographic assessment of left ventricular volumes, mass, and ejection fraction in neonates and infants with congenital heart disease: a comparison study with cardiac MRI. Circ Cardiovasc Imaging 3(6):735–742

    Article  PubMed  Google Scholar 

  4. Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43(6):1068–1074

    Article  PubMed  Google Scholar 

  5. Ghai A, Silversides C, Harris L, Webb GD, Siu SC, Therrien J (2002) Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol 40(9):1675–1680

    Article  PubMed  Google Scholar 

  6. Heusch A, Koch JA, Krogmann ON, Korbmacher B, Bourgeois M (1999) Volumetric analysis of the right and left ventricle in a porcine heart model: comparison of three-dimensional echocardiography, magnetic resonance imaging and angiocardiography. Eur J Ultrasound 9(3):245–255

    Article  CAS  PubMed  Google Scholar 

  7. Knauth AL, Gauvreau K, Powell AJ, Landzberg MJ, Walsh EP, Lock JE et al (2008) Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 94(2):211–216

    Article  CAS  PubMed  Google Scholar 

  8. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr 18(12):1440–1463

    Article  PubMed  Google Scholar 

  9. Lorenz CH, Walker ES, Morgan VL, Klein SS, Graham TP Jr (1999) Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J Cardiovasc Magn Reson 1(1):7–21

    Article  CAS  PubMed  Google Scholar 

  10. Malm S, Frigstad S, Sagberg E, Larsson H, Skjaerpe T (2004) Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging. J Am Coll Cardiol 44(5):1030–1035

    Article  PubMed  Google Scholar 

  11. Malm S, Sagberg E, Larsson H, Skjaerpe T (2005) Choosing apical long-axis instead of two-chamber view gives more accurate biplane echocardiographic measurements of left ventricular ejection fraction: a comparison with magnetic resonance imaging. J Am Soc Echocardiogr 18(10):1044–1050

    Article  PubMed  Google Scholar 

  12. Mohan JC, Sethi KK, Arora R, Khalilullah M (1992) Cross sectional echocardiographic left ventricular ejection fraction: method based variability. Indian Heart J 44(1):23–28

    CAS  PubMed  Google Scholar 

  13. Nikitin NP, Constantin C, Loh PH, Ghosh J, Lukaschuk EI, Bennett A et al (2006) New generation 3-dimensional echocardiography for left ventricular volumetric and functional measurements: comparison with cardiac magnetic resonance. Eur J Echocardiogr 7(5):365–372

    Article  PubMed  Google Scholar 

  14. Nosir YF, Vletter WB, Boersma E, Frowijn R, Ten Cate FJ, Fioretti PM et al (1997) The apical long-axis rather than the two-chamber view should be used in combination with the four-chamber view for accurate assessment of left ventricular volumes and function. Eur Heart J 18(7):1175–1185

    Article  CAS  PubMed  Google Scholar 

  15. Plein S, Smith WH, Ridgway JP, Kassner A, Beacock DJ, Bloomer TN et al (2001) Measurements of left ventricular dimensions using real-time acquisition in cardiac magnetic resonance imaging: comparison with conventional gradient echo imaging. MAGMA 13(2):101–108

    CAS  PubMed  Google Scholar 

  16. Riehle TJ, Mahle WT, Parks WJ, Sallee D 3rd, Fyfe DA (2008) Real-time three-dimensional echocardiographic acquisition and quantification of left ventricular indices in children and young adults with congenital heart disease: comparison with magnetic resonance imaging. J Am Soc Echocardiogr 21(1):78–83

    Article  PubMed  Google Scholar 

  17. Ryan T, Petrovic O, Dillon JC, Feigenbaum H, Conley MJ, Armstrong WF (1985) An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 5(4):918–927

    Article  CAS  PubMed  Google Scholar 

  18. van den Bosch AE, Robbers-Visser D, Krenning BJ, Voormolen MM, McGhie JS, Helbing WA et al (2006) Real-time transthoracic three-dimensional echocardiographic assessment of left ventricular volume and ejection fraction in congenital heart disease. J Am Soc Echocardiogr 19(1):1–6

    Article  PubMed  Google Scholar 

  19. Wahr DW, Wang YS, Schiller NB (1983) Left ventricular volumes determined by two-dimensional echocardiography in a normal adult population. J Am Coll Cardiol 1(3):863–868

    Article  CAS  PubMed  Google Scholar 

  20. Weber OM, Higgins CB (2006) MR evaluation of cardiovascular physiology in congenital heart disease: flow and function. J Cardiovasc Magn Reson 8(4):607–617

    Article  PubMed  Google Scholar 

  21. Wyatt HL, Meerbaum S, Heng MK, Gueret P, Corday E (1980) Cross-sectional echocardiography. III. Analysis of mathematic models for quantifying volume of symmetric and asymmetric left ventricles. Am Heart J 100(6 Pt 1):821–828

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA

    Jimmy C. Lu, Gregory J. Ensing, Sunkyung Yu, Thor Thorsson, Janet E. Donohue & Adam L. Dorfman

  2. University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, 1540 E. Hospital Dr, Ann Arbor, MI, 48109-4204, USA

    Jimmy C. Lu

Authors
  1. Jimmy C. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory J. Ensing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sunkyung Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thor Thorsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Janet E. Donohue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adam L. Dorfman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jimmy C. Lu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lu, J.C., Ensing, G.J., Yu, S. et al. 5/6 Area Length Method for Left-Ventricular Ejection-Fraction Measurement in Adults with Repaired Tetralogy of Fallot: Comparison with Cardiovascular Magnetic Resonance. Pediatr Cardiol 34, 231–239 (2013). https://doi.org/10.1007/s00246-012-0420-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-012-0420-7

Keywords

Search

Navigation