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Assessment of LVEF using a new 16-segment wall motion score in echocardiography

Abstract

Background: Simpson biplane method and 3D by transthoracic echocardiography (TTE), radionuclide angiography (RNA) and cardiac magnetic resonance imaging (CMR) are the most accepted techniques for left ventricular ejection fraction (LVEF) assessment. Wall motion score index (WMSI) by TTE is an accepted complement. However, the conversion from WMSI to LVEF is obtained through a regression equation, which may limit its use. In this retrospective study, we aimed to validate a new method to derive LVEF from the wall motion score in 95 patients.

Methods: The new score consisted of attributing a segmental EF to each LV segment based on the wall motion score and averaging all 16 segmental EF into a global LVEF. This segmental EF score was calculated on TTE in 95 patients, and RNA was used as the reference LVEF method. LVEF using the new segmental EF 15-40-65 score on TTE was compared to the reference methods using linear regression and Bland–Altman analyses.

Results: The median LVEF was 45% (interquartile range 32–53%; range from 15 to 65%). Our new segmental EF 15-40-65 score derived on TTE correlated strongly with RNA-LVEF (r = 0.97). Overall, the new score resulted in good agreement of LVEF compared to RNA (mean bias 0.61%). The standard deviations (s.d.s) of the distributions of inter-method difference for the comparison of the new score with RNA were 6.2%, indicating good precision.

Conclusion: LVEF assessment using segmental EF derived from the wall motion score applied to each of the 16 LV segments has excellent correlation and agreement with a reference method.

References

  1. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography 2015 28 1.e14–39.e14. (https://doi.org/10.1016/j.echo.2014.10.003)

    Article  Google Scholar 

  2. Corbett JR, Akinboboye OO, Bacharach SL, Borer JS, Botvinick EH, DePuey EG, Ficaro EP, Hansen CL, Henzlova MJ, Van Kriekinge S, et al. Equilibrium radionuclide angiocardiography. Journal of Nuclear Cardiology 2006 13 e56–e79. (https://doi.org/10.1016/j.nuclcard.2006.08.007)

    Article  Google Scholar 

  3. Bellenger NG, Davies LC, Francis JM, Coats AJ, Pennell DJ. Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance 2000 2 271–278. (https://doi.org/10.3109/10976640009148691)

    Article  CAS  Google Scholar 

  4. Lebeau R, Di Lorenzo M, Amyot R, Veilleux M, Lemieux R, Sauve C. A new tool for estimating left ventricular ejection fraction derived from wall motion score index. Canadian Journal of Cardiology 2003 19 397–404.

    Google Scholar 

  5. Hanneman SK. Design, analysis, and interpretation of method-comparison studies. AACN Advanced Critical Care 2008 19 223–234.

    PubMed  PubMed Central  Google Scholar 

  6. Berning J, Rokkedal Nielsen J, Launbjerg J, Fogh J, Mickley H, Andersen PE. Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis. Cardiology 1992 80 257–266. (https://doi.org/10.1159/000175011)

    Article  CAS  Google Scholar 

  7. Rifkin RD, Koito H. Comparison with radionuclide angiography of two new geometric and four nongeometric models for echocardiographic estimation of left ventricular ejection fraction using segmental wall motion scoring. American Journal of Cardiology 1990 65 1485–1490. (https://doi.org/10.1016/0002-9149(90)91360-I)

    Article  CAS  Google Scholar 

  8. Moller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pellikka PA. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. American Heart Journal 2006 151 419–425. (https://doi.org/10.1016/j.ahj.2005.03.042)

    Article  Google Scholar 

  9. Lebeau R, Serri K, Morice MC, Hovasse T, Unterseeh T, Piechaud JF, Garot J. Assessment of left ventricular ejection fraction using the wall motion score index in cardiac magnetic resonance imaging. Archives of Cardiovascular Diseases 2012 105 91–98. (https://doi.org/10.1016/j.acvd.2012.01.002)

    Article  Google Scholar 

  10. Duncan RF, Dundon BK, Nelson AJ, Pemberton J, Williams K, Worthley MI, Zaman A, Thomas H, Worthley SG. 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. Echocardiography 2011 28 597–604. (https://doi.org/10.1111/j.1540-8175.2011.01394.x)

    Article  Google Scholar 

  11. McGowan JH, Cleland JG. Reliability of reporting left ventricular systolic function by echocardiography: a systematic review of 3 methods. American Heart Journal 2003 146 388–397.

    Article  Google Scholar 

  12. Sierra-Galan LM, Ingkanisorn WP, Rhoads KL, Agyeman KO, Arai AE. Qualitative assessment of regional left ventricular function can predict MRI or radionuclide ejection fraction: an objective alternative to eyeball estimates. Journal of Cardiovascular Magnetic Resonance 2003 5 451–463. (https://doi.org/10.1081/JCMR-120022261)

    Article  Google Scholar 

  13. Baron T, Flachskampf FA, Johansson K, Hedin EM, Christersson C. Usefulness of traditional echocardiographic parameters in assessment of left ventricular function in patients with normal ejection fraction early after acute myocardial infarction: results from a large consecutive cohort. European Heart Journal: Cardiovascular Imaging 2016 17 413–420. (https://doi.org/10.1093/ehjci/jev160)

    PubMed  Google Scholar 

  14. Munk K, Andersen NH, Nielsen SS, Bibby BM, Botker HE, Nielsen TT, Poulsen SH. Global longitudinal strain by speckle tracking for infarct size estimation. European Journal of Echocardiography 2011 12 156–165. (https://doi.org/10.1093/ejechocard/jeq168)

    Article  Google Scholar 

  15. Eek C, Grenne B, Brunvand H, Aakhus S, Endresen K, Hol PK, Smith HJ, Smiseth OA, Edvardsen T, Skulstad H. Strain echocardiography and wall motion score index predicts final infarct size in patients with non-ST-segment-elevation myocardial infarction. Circulation: Cardiovascular Imaging 2010 3 187–194. (https://doi.org/10.1161/CIRCIMAGING.109.910521)

    Google Scholar 

  16. Munk K, Andersen NH, Terkelsen CJ, Bibby BM, Johnsen SP, Botker HE, Nielsen TT, Poulsen SH. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. Journal of the American Society of Echocardiography 2012 25 644–651. (https://doi.org/10.1016/j.echo.2012.02.003)

    Article  Google Scholar 

  17. Galasko GI, Basu S, Lahiri A, Senior R. A prospective comparison of echocardiographic wall motion score index and radionuclide ejection fraction in predicting outcome following acute myocardial infarction. Heart 2001 86 271–276. (https://doi.org/10.1136/heart.86.3.271)

    Article  CAS  Google Scholar 

  18. Jurado-Roman A, Agudo-Quilez P, Rubio-Alonso B, Molina J, Diaz B, Garcia-Tejada J, Martin R, Tello R. Superiority of wall motion score index over left ventricle ejection fraction in predicting cardiovascular events after an acute myocardial infarction. European Heart Journal: Acute Cardiovascular Care 2016 [epub]. (https://doi.org/10.1177/2048872616674464)

    Google Scholar 

  19. Carluccio E, Tommasi S, Bentivoglio M, Buccolieri M, Prosciutti L, Corea L. Usefulness of the severity and extent of wall motion abnormalities as prognostic markers of an adverse outcome after a first myocardial infarction treated with thrombolytic therapy. American Journal of Cardiology 2000 85 411–415. (https://doi.org/10.1016/S0002-9149(99)00764-X)

    Article  CAS  Google Scholar 

  20. Lebeau R, Sas G, El Rayes M, Serban A, Moustafa S, Essadiqi B, DiLorenzo M, Souliere V, Beaulieu Y, Sauve C, et al. Left ventricular ejection fraction assessment by non-cardiologists from transverse views using a simplified wall motion score index. Echo Research and Practice 2015 2 1–8. (https://doi.org/10.1530/ERP-14-0003)

    Article  Google Scholar 

  21. Lebeau R, Potter B, Sas G, Moustafa S, di Lorenzo M, Souliere V, Beaulieu Y, Sauve C, Amyot R, Serri K. Performance of a simplified wall motion score index method for noncardiologists to assess left ventricular ejection fraction. ISRN Emergency Medicine 2012 2012 article ID 309470. (https://doi.org/10.5402/2012/309470)

  22. Dorosz JL, Lezotte DC, Weitzenkamp DA, Allen LA, Salcedo EE. Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis. JACC: Journal of the American College of Cardiology 2012 59 1799–1808. (https://doi.org/10.1016/j.jacc.2012.01.037)

    Article  Google Scholar 

  23. Hoffmann R, Barletta G, von Bardeleben S, Vanoverschelde JL, Kasprzak J, Greis C, Becher H. Analysis of left ventricular volumes and function: a multicenter comparison of cardiac magnetic resonance imaging, cine ventriculography, and unenhanced and contrast-enhanced two-dimensional and three-dimensional echocardiography. Journal of the American Society of Echocardiography 2014 27 292–301. (https://doi.org/10.1016/j.echo.2013.12.005)

    Article  Google Scholar 

  24. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. Journal of the American Society of Echocardiography 2010 23 1225–1230. (https://doi.org/10.1016/j.echo.2010.10.005)

    Article  Google Scholar 

  25. Farsi D, Hajsadeghi S, Hajighanbari MJ, Mofidi M, Hafezimoghadam P, Rezai M, Mahshidfar B, Abiri S, Abbasi S. Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases. Journal of Ultrasound 2017 20 133–138. (https://doi.org/10.1007/s40477-017-0246-5)

    Article  Google Scholar 

  26. Heiberg J, El-Ansary D, Canty DJ, Royse AG, Royse CF. Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care. Anaesthesia 2016 71 1091–1100. (https://doi.org/10.1111/anae.13525)

    Article  CAS  Google Scholar 

  27. Mulvagh SL, Rakowski H, Vannan MA, Abdelmoneim SS, Becher H, Bierig SM, Burns PN, Castello R, Coon PD, Hagen ME, et al. American Society of Echocardiography Consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. Journal of the American Society of Echocardiography 2008 21 1179–1201. (https://doi.org/10.1016/j.echo.2008.09.009)

    Article  Google Scholar 

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Acknowledgments

The authors thank all medical staff from the Sacré-Coeur Hospital echocardiography laboratory who collaborated to the project. They gratefully acknowledge Sylvie Loranger for secretarial assistance, Lea Scaini and her colleagues for support with bibliographical search, and Jonathan Béland for his technical support.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Correspondence to Real Lebeau.

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Lebeau, R., Serri, K., Di Lorenzo, M. et al. Assessment of LVEF using a new 16-segment wall motion score in echocardiography. Echo Res Pract 5, 63–69 (2018). https://doi.org/10.1530/ERP-18-0006

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