Visual versus fully automated assessment of left ventricular ejection fraction

Abstract

Introduction: The aim of this study is to compare three different methods commonly used in the assessment of left ventricle (LV) ejection fraction (EF) by echocardiography. Methodology: all patients underwent full echocardiography imaging that includes assessment of LVEF using M-mode, Automated EF (Auto-EF) through tracing the myocardial borders during systole and diastole, and visual EF estimation by two readers. Results: We enrolled 268 patients. Auto-EF measurement was feasible in 240 (89.5%) patients. The averaged LVEF was (52%12) with the visual assessment, (51%11) with Auto-EF and (57%13) with M-mode. Using Bland-Altman analysis we found that the difference between the mean visual and the Auto-EF was not significant [−0.3% (−0.5803–0.0053), p = 0.054]. However, we found a significant difference in the mean EF between the visual versus M-mode and Auto-EF versus M-mode with the mean differences: [−2.4365(−2.9946–1.8783), p < 0.0001] and [−2.1490 (−2.7348–1.5631), p < 0.0001] respectively. Inter-observer variability analysis of the visual EF assessment between the two readers showed that intraclass correlation coefficient was 0.953, (95% confidence interval: 0.939–0.965, p < 0.0001), with excellent correlation between the two readers: R = 0.911, p < 0.0001). Conclusion: The two-dimensional echocardiographic methods using Biplane Auto-EF or visual assessment were significantly comparable, whereas M-mode results in an overestimation of the LV ejection fraction.