What is the most accurate way to measure ejection fraction

1. Grimm W, Glaveris C, Hoffmann J, Mena V, Mey N, Born S, Maisch B. Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy: design and first results of the Marburg Cardiomyopathy Study. Pacing Clin Electrophysiol 1998;21:2551–2556. [PubMed] [Google Scholar]

2. Grimm W, Christ M, Bach J, Muller HH, Maisch B. Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy: results of the Marburg Cardiomyopathy Study. Circulation 2003;108:2883–2891. [PubMed] [Google Scholar]

3. Klein H, Auricchio A, Reek S, Geller C. New primary prevention trials of sudden cardiac death in patients with left ventricular dysfunction: SCD-HEFT and MADIT-II. Am J Cardiol 1999;83:91D–97D. [PubMed] [Google Scholar]

4. Theal M, Demers C, Mckelvie RS. The role of angiotensin II receptor blockers in the treatment of heart failure patients. Congest Heart Fail 2003;9:29–34. [PubMed] [Google Scholar]

5. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358–367. [PubMed] [Google Scholar]

6. Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, Van Train KF, Berman DS. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138–2147. [PubMed] [Google Scholar]

7. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307–310. [PubMed] [Google Scholar]

8. Kondo C, Fukushima K, Kusakabe K. Measurement of left ventricular volumes and ejection fraction by quantitative gated SPET, contrast ventriculography and magnetic resonance imaging: a meta-analysis. Eur J Nucl Med Mol Imaging 2003;30:851–858. [PubMed] [Google Scholar]

9. Yoshioka J, Hasegawa S, Yamaguchi H, Tokita N, Paul AK, Xiuli M, Maruyama A, Hori M, Nishimura T. Left ventricular volumes and ejection fraction calculated from quantitative electrocardiographic-gated 99mTc-tetrofosmin myocardial SPECT. J Nucl Med 1999;40:1693–1698. [PubMed] [Google Scholar]

10. Williams KA, Taillon LA. Left ventricular function in patients with coronary artery disease assessed by gated tomographic myocardial perfusion images. Comparison with assessment by contrast ventriculography and first-pass radionuclide angiography. J Am Coll Cardiol 1996;27:173–181. [PubMed] [Google Scholar]

11. Hoffmann R, von Bardeleben S, Ten Cate F, Borges AC, Kasprzak J, Firschke C, Lafitte S, Al-Saadi N, Kuntz-Hehner S, Engelhardt M, Becher H, Vanoverschelde JL. Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. Eur Heart J 2004;Dec 17[Epub ahead of print]. [PubMed]

12. Abe M, Kazatani Y, Fukuda H, Tatsuno H, Habara H, Shinbata H. Left ventricular volumes, ejection fraction, and regional wall motion calculated with gated technetium-99m tetrofosmin SPECT in reperfused acute myocardial infarction at super-acute phase: comparison with left ventriculography. J Nucl Cardiol 2000;7:569–574. [PubMed] [Google Scholar]

13. Bernard Y, Meneveau N, Boucher S, Magnin D, Anguenot T, Schiele F, Vuillemenot A, Bassand JP. Lack of agreement between left ventricular volumes and ejection fraction determined by two-dimensional echocardiography and contrast cineangiography in postinfarction patients. Echocardiography 2001;18:113–122. [PubMed] [Google Scholar]

14. Nichols K, Tamis J, DePuey EG, Mieres J, Malhotra S, Rozanski A. Relationship of gated SPECT ventricular function parameters to angiographic measurements. J Nucl Cardiol 1998;5:295–303. [PubMed] [Google Scholar]

15. Vourvouri EC, Poldermans D, Bax JJ, Sianos G, Sozzi FB, Schinkel AF, de Sutter J, Parcharidis G, Valkema R, Roelandt JR. Evaluation of left ventricular function and volumes in patients with ischaemic cardiomyopathy: gated single-photon emission computed tomography versus two-dimensional echocardiography. Eur J Nucl Med 2001;28:1610–1615. [PubMed] [Google Scholar]

16. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, Deedwania PC, Ney DE, Snavely DB, Chang PI. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 1997;349:747–752. [PubMed] [Google Scholar]

17. McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J. Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators. Circulation 1999;100:1056–1064. [PubMed] [Google Scholar]

18. Moss AJ, Zareba W, Hall WJ, Klein H. Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–883. [PubMed] [Google Scholar]

19. Riegger GA, Bouzo H, Petr P, Munz J, Spacek R, Pethig H, von Behren V, George M, Arens H. Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators. Circulation 1999;100:2224–2230. [PubMed] [Google Scholar]

20. Centers for Medicare and Medicaid Services. National Voluntary Hospital Reporting Initiative. Data Details. Technical Appendix. Heart Attack (Acute Myocardial Infarction AMI). Available at: http://www.medicare.gov/Hospital/Home.asp?dest=Nav|Home|DataDetails|TechnicalAppendix-TabTop. Accessed November 1, 2004.

21. Joint Commission on Accreditation of Healthcare Organizations. NFQ-Endorsed Voluntary Consensus Standards for Hospital Care. Measure Information Form. Available at: http://www.jcaho.org/pms/core+measures/3d_ami3.pdf. Accessed November 1, 2004.

22. Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP, Calkins H. Hoch D, Goldberger J, Shalaby A, Sanders WE, Schaechter A, Levine JH; Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004;350:2151–2158. [PubMed] [Google Scholar]

23. Albrechtsson U, Eskilsson J, Lomsky M, Stubbe I, Svensson SE, Tylen U. Comparison of left ventricular ejection fraction assessed by radionuclide angiocardiography, echocardiography and contrast angiocardiography. Acta Med Scand 1982; 211:147–152. [PubMed] [Google Scholar]

24. Casans Tormo I, Gomez Aldaravi R, Bodi Peris V, Sanchis Fores J, Ciudad Platero J, Insa Perez L, Manjon Soriano J. Determination of ejection fraction and left ventricular fraction using isotopic ventriculography and bidimensional echocardiography. Comparison with contrast ventriculography. Rev Esp Cardiol 1998;51(suppl 1):10–18. [PubMed] [Google Scholar]

25. Okizaki A, Shuke N, Sato J. Ishikawa Y, Yamamoto W, Kikuchi K, Aburano T. Improved accuracy in estimation of left ventricular function parameters from QGS software with Tc-99m tetrofosmin gated-SPECT: a multivariate analysis. Ann Nucl Med 2003;17:575–582. [PubMed] [Google Scholar]


Page 2

Comparison of patient LVEF values obtained by noninvasive (echocardiography and/or SPECT and invasive (angiography) studies within one month of each other.

Method A versus Method BNumber of StudiesLVEF, Method A (% ± S.E.)LVEF, Method B (% ± S.E.)Difference (% ± S.E.)p-value
Echo versus Angio20249 ± 1.054 ± 1.0−5 ± 0.8<0.0001
SPECT versus Angio54249 ± 0.657 ± 0.6−8 ± 0.5<0.0001
Echo versus SPECT20149 ± 1.047± 1.0+2 ± 0.80.0018