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How reliable are left ventricular ejection fraction cut offs assessed by echocardiography for clinical decision making in patients with heart failure?

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Abstract

We aimed to study the potential influence of the variability in the assessment of echocardiographically measured left ventricular ejection fraction (LVEF) on indications for the implantation of internal cardioverter defibrillator and/or cardiac resynchronization devices in heart failure patients. TIME-CHF was a multicenter trial comparing NT-BNP versus symptom-guided therapy in patients aged ≥60 years. Patients had their LVEF assessed at the recruiting centre using visual assessment, the area-length or biplane Simpson’s method. Echocardiographic data were transferred to the study core-lab for re-assessment. Re-assessment in the core-lab was done with biplane Simpson’s method, and included an appraisal of image quality. 413 patients had the LVEF analyzed at the recruiting centre and at the core lab. Image quality was optimal in 191 and suboptimal in 222. Overall, the correlation between LVEF at the recruiting centres and at the core-lab was good, independent of image quality (R² = 0.62). However, when a LVEF ≤30 % or ≥30 % was used as a cut-off, about 20 % of all patients would have been re-assigned to having either a LVEF above or below the cut-off, this proportion was not significantly influenced by image quality. We conclude that correlation between LVEF assessed by different centres based on the same ultrasound data is good, regardless of image quality. However, one fifth of patients would have been re-assigned to a different category when using the clinically important cut-off of 30 %.

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Acknowledgments

Dr. Kaufmann is supported by a SCORE grant (SNF 32323B_123919/1) from the Swiss National Science Foundation. TIME-CHF was supported by the Horten Research Foundation (Lugano, Switzerland; >55 % of the study’s budget), as well as by smaller unrestricted grants from AstraZeneca Pharma, Novartis Pharma, Menarini Pharma, Pfizer Pharma, Servier, Roche Diagnostics, Roche Pharma, and Merck Pharma.

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None declared.

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Authors and Affiliations

  1. Division of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Beat A. Kaufmann, Son Y. Min, Kaatje Goetschalckx, Alain M. Bernheim, Peter T. Buser, Matthias E. Pfisterer & Hans-Peter Brunner-La Rocca

  2. Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands

    Hans-Peter Brunner-La Rocca

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  1. Beat A. Kaufmann
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  2. Son Y. Min
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  3. Kaatje Goetschalckx
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  4. Alain M. Bernheim
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  7. Hans-Peter Brunner-La Rocca
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Correspondence to Beat A. Kaufmann.

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Kaufmann, B.A., Min, S.Y., Goetschalckx, K. et al. How reliable are left ventricular ejection fraction cut offs assessed by echocardiography for clinical decision making in patients with heart failure?. Int J Cardiovasc Imaging 29, 581–588 (2013). https://doi.org/10.1007/s10554-012-0122-5

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  • DOI: https://doi.org/10.1007/s10554-012-0122-5

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