Open AccessSensitivity and specificity of left ventricular ejection fraction by echocardiographic automated border detection: Comparison with radionuclide ventriculography
Author(s) -
Lucariello Richard J.,
Sun Ying,
Doganay Guldene,
Chiaramida Salvatore A.
Publication year - 1997
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960201108
Subject(s) - medicine , radionuclide ventriculography , ejection fraction , receiver operating characteristic , nuclear medicine , ventricular function , cardiology , bland–altman plot , limits of agreement , beat (acoustics) , heart failure , physics , acoustics
Background : Echocardiographic automated border detection (ABD) provides on‐line, beat‐to‐beat estimation of left ventricular (LV) ejection fraction (EF). Sensitivity and specificity of using ABD‐EF for diagnosing LV dysfunction in routine clinical situations have not been previously studied. Hypothesis : Analysis of ABD‐EF data based on receiver operating characteristic (ROC) should provide useful information about sensitivity and specificity for clinical diagnosis of LV function based on ABD‐EF. Methods : The study group included 50 consecutive patients with EF measured by both ABD and radionuclide ventriculography (RVG). ABD‐EF was recorded for 25 consecutive heart beats in the apical four‐chamber view. Data were analyzed statistically by linear regression, Bland‐Altman plot, and ROC. In ROC analysis, abnormal LV function was defined RVG‐EF ≤ 40%. Results: ABD and RVG showed a moderate correlation in the EF measurements: slope=0.93, intercept=17%, r=0.79 (n = 50). Interbeat variability in ABD was diminished by averaging consecutive beats; standard error of estimate (SEE) decreased from 15.6% without averaging to 12.5% with 25‐beat averaging. Bland‐Altman analysis indicated that ABD‐EF compared unfavorably with RVG‐EF, with limits of agreement from ‐11% to 39%. ABD‐EF showed a systematic overestimation (p<0.005), which was compensated by increasing the threshold for abnormal ABD‐EF to 56%. With the optimized threshold, ABD‐EF provided 89% sensitivity and 89% specificity (85% overall diagnostic accuracy) for diagnosing abnormal LV function. Conclusion : This study explored the limitations of on‐line echocardiographic measurement of EF in a clinical setting and provided useful data for assessing interbeat variability, sensitivity, and specificit.