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European Journal of Echocardiography 2006 7(4):284-292; doi:10.1016/j.euje.2005.06.004
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Copyright © 2005, The European Society of Cardiology

The effect of ventricular pacing on measurements of left ventricular function: A comparison between echocardiographic methods and with radionuclide ventriculography*

Simon D.R. Thackraya,*, Graham A. Wrightb, Klaus K.A. Wittea, Nikolay P. Nikitina, Ann C. Tweddelb, Andrew L. Clarka and John G.F. Clelanda

aDepartment of Academic Cardiology, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, UK
bDepartment of Nuclear Medicine, Hull Royal Infirmary, Kingston-upon-Hull, UK

Received 10 May 2005; received in revised form 10 May 2005; accepted after revision 1 June 2005.

* Corresponding author. Tel.: +44 1482 624073; fax: +44 1482 624084. simonthackray{at}hotmail.com


  Abstract

Aims Different methods exist for measuring left ventricular function echocardiographically; each may be error prone due to the abnormal pattern of ventricular activation during pacing.

Methods and results Echocardiography was undertaken on 307 patients with permanent pacemakers; a subset of 57 underwent radionuclide ventriculography. Intrinsic and paced beats were analysed for left ventricular function by: Simpson's bi-plane, Teicholz M-mode, wall-motion scoring and ‘eyeball’ assessment. Agreement between techniques and with radionuclide ventriculography were compared according to intrinsic or paced beats. Echocardiographic measures of ejection fraction give mean values 5% higher than radionuclide ventriculography (Simpson's 30±9%, vs. Teicholz 30±13% vs. radionuclide ventriculography 25±9%, p=0.03). Agreement between Simpson's, Teicholz and radionuclide ventriculography by Bland–Altman analysis showed poor agreement (Simpson's vs. Teicholz range (4xSD)=57%, Simpson's vs. radionuclide ventriculography=36%, Teicholz vs. radionuclide ventriculography=46%, p=0.02), the level of agreement deteriorates with ventricular pacing (Simpson's vs. Teicholz range=61%, Simpson's vs. radionuclide ventriculography=34%, Teicholz vs. radionuclide ventriculography=47%, p=0.02). The correlation between wall motion analysis and radionuclide ventriculography is moderately poor (all subjects r=0.58, ventricular pacing r=0.52, not pacing r=0.66).

Conclusion Echocardiography and radionuclide ventriculography are the only non-invasive techniques to assess left ventricular function in the paced population. Results are poorly interchangeable and the accuracy of any comparison dependent on the underlying rhythm.

Keywords: Pacemaker; Echocardiography; Heart failure

* This work is supported by the British Heart Foundation.


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