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European Journal of Echocardiography 2008 9(2):250-254; doi:10.1016/j.euje.2007.03.025
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Assessment of left ventricular ejection fraction after myocardial infarction using contrast echocardiography

Tjebbe W. Galema*, Marcel L. Geleijnse, Sing-Chien Yap, Ron T. van Domburg, Elena Biagini, Wim B. Vletter and Folkert J. Ten Cate

Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands

Received 30 November 2006; accepted after revision 16 March 2007; online publish-ahead-of-print 10 May 2007.

* Corresponding author: Department of Cardiology, Thoraxcenter, Room Ba 350, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Tel: +31 10 463 5356; fax: +31 10 463 5513. E-mail address: t.w.galema{at}erasmusmc.nl


  Abstract

Aims: Despite its relatively high intra- and inter-observer variability for left ventricular ejection fraction (LV-EF) echocardiography is clinically still the most used modality to assess LV-EF. We studied whether adding a second-generation microbubble contrast agent could decrease this variability.

Methods and results: Forty-eight patients underwent transthoracic echocardiography in second-harmonic mode (SHI) with and without contrast within 5 days after an acute myocardial infarction. LV-EF was determined using the Simpson's biplane method. With contrast intra-observer variability decreased from 12.5 ± 11.5% to 7.0 ± 7.0% (P < 0.001) and inter-observer variability decreased from 16.9 ± 9.9% to 7.0 ± 6.2% (P < 0.001). Bland–Altman analysis confirmed these findings by demonstrating smaller 95% limits of agreement for both the intra- and inter-observer variability when contrast was used. This improvement in intra- and inter-observer variability was seen to a comparable extent in patients with moderate-to-poor and good quality SHI echocardiograms.

Conclusion: Echo contrast significantly improves intra- and inter-observer variability for LV-EF, both in patients with moderate-to-poor and good quality SHI echocardiograms.

Keywords: Echocardiography; Contrast; Ejection fraction; Myocardial infarction


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