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Left ventricular ejection fraction: real-world comparison between cardiac computed tomography and echocardiography in a large population

La frazione di eiezione del ventricolo sinistro: confronto nel mondo reale tra cardio-TC ed ecocardiografia in un’ampia popolazione

  • Cardiac Radiology/Cardioradiologia
  • Published:
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Abstract

Purpose

This study compared cardiac computed tomography (CT) and two-dimensional transthoracic echocardiography (ECC) for assessing left ventricular ejection fraction (LVEF) using real-world data from a large patient population.

Materials and methods

We studied 450 patients (284 males; mean age 64±12 years; range 12–88) who underwent CT and ECC due to suspected coronary artery disease. For CT, we used multiphase short-axis reconstructions and evaluated them with a dedicated software tool that uses Simpson’s rule to compute LV volumes. For ECC, computation was based on the biplane Simpson’s method. Results in terms of EF were compared with the paired Student’s t test, Pearson’s correlation coefficient (r), and Bland-Altman analysis.

Results

EF was 52%±15% for CT and 55%±13% for ECC. Statistically significant differences, albeit with good correlation, were observed between the measurements (r=0.71; p<0.05). ECC showed a slight tendency to overestimate EF. When the population was divided into subgroups according to EF, this was underestimated by ECC in the subgroup with EF >50% and overestimated in those with EF 35%–50% and <35%, with consistently significant differences between ECC and CT (p<0.05) and progressively lower levels of agreement.

Conclusions

In the real-world assessment of EF, ECC provides significantly different data from CT, with a bias that increases proportionally to LV systolic dysfunction.

Riassunto

Obiettivo

Obiettivo di questo studio è stato quello di confrontare la tomografia computerizzata (TC) del cuore con l’ecocardiogramma trans-toracico 2D (ECC) nel valutare la frazione di eiezione (FE) del ventricolo sinistro (Vsin) in una vasta popolazione di pazienti utilizzando dati provenienti dal mondo reale.

Materiali e metodi

Abbiamo incluso 450 pazienti (284 uomini; età media 64±12 anni; 12–88) che sono stati sottoposti a TC e a ECC per sospetta malattia coronarica; per la TC abbiamo utilizzato delle ricostruzioni multifasiche secondo un piano asse corto e le abbiamo valutate con un software dedicato, basato sul calcolo dei volumi del Vsin con la regola di Simpson; per l’ECC abbiamo utilizzato un calcolo basato sulla regola di Simpson biplanare. I risultati ottenuti per la FE sono stati analizzati con un test t di Student a due code per dati appaiati, una correlazione r di Pearson ed una analisi di Bland-Altman.

Risultati

La FE è stata 52%±15% per la TC e 55%±13% per l’ECC. Sono state osservate differenze statisticamente significative, anche se con buona correlazione, tra le misurazioni effettuate (r=0,71; p<0,05). L’ECC ha mostrato una lieve tendenza a sovrastimare la FE. Dividendo la nostra popolazione in sotto-gruppi, la FE è stata sottostimata dall’ECC nel sotto-gruppo con valori di FE>50%, ed è stata sovrastimata nei sotto-gruppi con FE compresa tra 35% e 50% ed in quello con FE<35%, con differenze tra TC ed ECC che si sono rivelate sempre significative (p<0,05) con una concordanza progressivamente più bassa.

Conclusioni

L’ECC fornisce valori di FE che sono significativamente differenti rispetto alla TC nel mondo reale, con un bias che aumenta proporzionalmente alla disfunzione sistolica del ventricolo sinistro.

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Authors and Affiliations

  1. Dipartimento di Radiologia e Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy

    E. Maffei, G. Messalli, A. Palumbo, C. Martini, S. Seitun, A. Aldrovandi, A. Cuttone, E. Emiliano & F. Cademartiri

  2. Dipartimento di Radiologia e Cardiologia, Erasmus Medical Center, Rotterdam, The Netherlands

    A. Palumbo, C. Martini, A. Weustink, N. Mollet & F. Cademartiri

  3. Dipartimento di Radiologia, Università degli Studi di Napoli “Federico II”, Napoli, Italy

    G. Messalli

  4. Dipartimento di Radiologia, SDN Fondazione IRCCS, Napoli, Italy

    G. Messalli

  5. Dipartimento di Radiologia, Università di Verona, Verona, Italy

    R. Malagò

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  1. E. Maffei
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  2. G. Messalli
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  3. A. Palumbo
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  8. E. Emiliano
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  9. R. Malagò
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Correspondence to F. Cademartiri.

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Maffei, E., Messalli, G., Palumbo, A. et al. Left ventricular ejection fraction: real-world comparison between cardiac computed tomography and echocardiography in a large population. Radiol med 115, 1015–1027 (2010). https://doi.org/10.1007/s11547-010-0542-z

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  • DOI: https://doi.org/10.1007/s11547-010-0542-z

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