Função Sistólica não é Fração de Ejeção!! Qual o melhor método?

Abaixo alguns artigos que merecem ser lidos na íntegra por todos Ecocardiografistas.

Um número, é isso o que muitos olham a receber um laudo de ecocardiograma a Fração de Ejeção... Bom, não vamos entrar nesta discussão, neste momento. Mas qual o melhor método? E a análise da contratilidade segmentar? Isso vai dar muito pano para manga...

A Study of the 16-Segment Regional Wall Motion Scoring Index and Biplane Simpson’s Rule for the Calculation of Left Ventricular Ejection Fraction: A Comparison with Cardiac Magnetic Resonance Imaging

Rae F. Duncan, M.B.Ch.B., B.Sc., M.Sc., M.R.C.P.,∗† Ben K. Dundon, M.B.B.S., F.R.A.C.P.,∗ Adam J. Nelson, B.Sc., M.B.B.S.,∗ James Pemberton, M.B.B.S., M.D., M.R.C.P.,† Kerry Williams, Dip. Appl. Sci.,∗ Matthew I. Worthley, M.B.B.S., Ph.D., F.R.A.C.P.,∗ Azfar Zaman, M.B.Ch.B., B.Sc., M.D., F.R.C.P.,† Honey Thomas, M.B.B.S., M.D., M.R.C.P.,† and Stephen G. Worthley, M.B.B.S., Ph.D., F.R.A.C.P.∗

∗Cardiovascular Research Centre, Royal Adelaide Hospital and University of Adelaide, Adelaide, South
Australia, Australia; and †Cardiology, The Freeman Hospital and Institute of Cellular Medicine, Newcastle
University, Newcastle-upon-Tyne, UK
 

Aims: Accurate calculation of left ventricular ejection fraction (LVEF) is important for diagnostic, prognostic and therapeutic reasons. Cardiac magnetic resonance (CMR) is the reference standard for LVEF calculation, followed by real time three-dimensional echocardiography (RT3DE). Limited availability of CMR and RT3DE leaves Simpson’s rule as the two-dimensional echocardiography (2DE) standard by which LVEF is calculated. We investigated the accuracy of the 16-Segment Regional Wall Motion Score Index (RWMSI) as an alternative method for calculating LVEF by 2DE and compared this to Simpson’s rule and CMR.

Methods and Results: The 2D echocardiograms of 110 patients were studied (LVEF range: 7–74%); 57 of these underwent CMR. A RWMS was applied, based on the consensus opinion of two experienced cardiologists, to each of 16 American Heart Association myocardial segments (RWMSI: hyperkinesis = 3; normal regional contraction = 2; mild hypokinesis = 1.25; severe hypokinesis = 0.75; akinesis = 0; dyskinesis = –1). LVEF was calculated by: LVEF(%) = (16segRWMS)/16×30. LVEF was calculated by Simpson’s rule and CMR using standard methods. Results were correlated against CMR. Intertechnique agreement was examined. A P value of<0.05 was considered significant. RWMSI-LVEF correlated strongly with Biplane Simpson’s rule (P< 0.001, r = 0.915). RWMSI-LVEF had a strong correlation to CMR (P < 0.001, r = 0.916); Simpson’s rule-LVEF had a moderate correlation to CMR (P<0.001, r = 0.647). In patients with LV dysfunction (EF < 55%), on linear regression analysis, RWMSILVEF had a better correlation with CMR than Simpson’s rule. Further more Simpson’s rule overestimated LVEF compared to CMR (mean difference: –6.12 ± 16.44, P = 0.002) whereas RWMSI did not (mean difference: 2.58 ± 14.80, P = NS).

Conclusion: RWMSI-LVEF correlates strongly with CMR with good intertechnique agreement. In centers where CMR and RT3DE are not readily available, the use by experienced individuals, of the RWMSI for calculating LVEF may be a more simple, accurate, and reliable alternative to Simpson’s rule. (Echocardiography 2011;28:597-604)

Reliability of Visual Assessment of Global and Segmental Left Ventricular Function: A Multicenter Study by the Israeli Echocardiography Research Group

David S. Blondheim, MD, Ronen Beeri, MD, Micha S. Feinberg, MD, Mordehay Vaturi, MD, Sarah Shimoni, MD, Wolfgang Fehske, MD, Alik Sagie, MD, David Rosenmann, MD, Peter Lysyansky, PhD, Lisa Deutsch, PhD, Marina Leitman, MD, Rafael Kuperstein, MD, Ilan Hay, MD, Dan Gilon, MD, Zvi Friedman, PhD, Yoram Agmon, MD, Yossi Tsadok, BSc, and Noah Liel-Cohen, MD, Hadera, Jerusalem, Tel Aviv, Petah Tikva, Rehovot, Haifa, Zerifin, and Beer Sheva, Israel; Cologne, Germany

Background: The purpose of this multicenter study was to determine the reliability of visual assessments of segmental wall motion (WM) abnormalities and global left ventricular function among highly experienced echocardiographers using contemporary echocardiographic technology in patients with a variety of cardiac conditions.

Methods: The reliability of visual determinations of left ventricular WM and global function was calculated from assessmentsmade by 12 experienced echocardiographers on 105 echocardiograms recorded using contemporary echocardiographic equipment. Ten studies were reread independently to determine intraobserver reliability.

Results: Interobserver reliability for visual differentiation between normal, hypokinetic, and akinetic segments

had an intraclass correlation coefficient of 0.70. The intraclass correlation coefficient for dichotomizing segments into normal versus other abnormal was 0.63, for hypokinetic versus other scores was 0.26, and for akinetic versus other scores was 0.58. Similar results were found for intraobserver reliability. Interobserver

reliability for WM score index was 0.84 and for left ventricular ejection fraction was 0.78. Similar values

were obtained for the intraobserver reliability of WM score index and ejection fraction. Compared to angiographic data, the accuracy of segmental WM assessments was 85%, and correct determination of the culprit artery was achieved in 59% of patients with myocardial infarctions.

Conclusion: Among experienced readers using contemporary echocardiographic equipment, interobserver and intraobserver reliability was reasonable for the visual quantification of normal and akinetic segments but poor for hypokinetic segments. Reliability was good for the visual assessment of global left ventricular function by WM score index and ejection fraction. (J Am Soc Echocardiogr 2010;23:258-64.)