Apical four-chamber and biplane Simpson's methods showed a 4.7% discordance rate at the HFrEF threshold, with left ventricular end-diastolic volume being the dominant independent predictor.
Observational (n=784)
No
Does apical four-chamber LVEF measurement differ from biplane Simpson's method at clinically actionable thresholds in patients undergoing echocardiography?
Discordance between A4C and biplane Simpson LVEF measurements is frequent near therapeutic cut-offs and in dilated ventricles, supporting the preference for biplane quantification in these scenarios.
Abstract Background Left ventricular ejection fraction (LVEF) remains central to heart failure phenotyping and device-based decision-making, yet the degree to which apical four-chamber (A4C) and biplane Simpson measurements diverge at clinically actionable thresholds is not well defined. Methods We analysed 1,022 unique algorithmically derived echocardiographic studies from 784 patients in the credentialed MIMIC-IV-ECHO-Ext-LVVOLUMES-A4C-ROI resource. Each study contained paired A4C and biplane volumetric labels derived from the same annotated DICOM sequence. Discordance was defined primarily at the HFrEF threshold (LVEF < 40%). Agreement was assessed with Bland–Altman analysis, and independent predictors were evaluated using multivariable logistic regression with cluster-robust standard errors. Results LVEF discordance at the HFrEF threshold occurred in 48 of 1,022 studies (4.7%, 95% CI 3.5–6.2%). At the ICD threshold (LVEF < 35%), discordance was present in 32 studies (3.1%). In the prespecified borderline zone (A4C LVEF 35–45%; n = 81), discordance rose to 30.9% (95% CI 21.9–41.6%). Mean bias was 0.11%, but the 95% limits of agreement were wide (− 13.5% to + 13.7%). LV end-diastolic volume was the only independent predictor of discordance (OR 1.61 per SD, 95% CI 1.27–2.05; p = 0.0001), and this association persisted after adjustment for acquisition variables. Conclusions Discordance between A4C and biplane Simpson LVEF is uncommon across an unselected cohort but becomes frequent near therapeutic cut-offs. LV dilatation is the dominant driver. These findings support continued preference for biplane quantification when the ventricle is enlarged or the measured LVEF falls near a treatment threshold.
İşleyen et al. (Sat,) conducted a observational in Left ventricular ejection fraction assessment (n=784). Apical four-chamber (A4C) method vs. Biplane Simpson's method was evaluated on Discordance in categorical classification at the HFrEF threshold (LVEF <40% versus ≥40%) (95% CI 3.5-6.2). Apical four-chamber and biplane Simpson's methods showed a 4.7% discordance rate at the HFrEF threshold, with left ventricular end-diastolic volume being the dominant independent predictor.