Three-dimensional Real-time Triplane versus Biplane Simpson for left ventricular ejection fraction estimation after ST-Segment Elevation Myocardial Infarction

Purpose : The Biplane Simpson (BPS) remains the recommended 2-dimensional method to assess left ventricular ejection fraction (LVEF). However, it has known limitations that may be overcome with 3D real-time triplane (RTTP), for instance, obtaining all apical views simultaneously at the same cardiac cycle. Accurate LVEF measurement is of utmost importance, as it guides the allocation of many treatments that reduce morbidity and mortality in heart failure. We sought to compare LVEF and volumes assessed by BPS and RTTP, using 3D LV full volume as reference, in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results : Prospective study that included consecutive STEMI patients. LV volumes and EF were compared between BPS and RTTP and the reference method. Fifty-two patients were studied and anterior MI was the most frequent location (44%). There was strong correlation between EF measured by BPS (r=0.80, p<0.001) and RTTP (r=0.91, p<0.001) versus the reference method, with significant difference between coefficients (0.11, p=0.034). EF by BPS attained a good inter-operator agreement, with an intraclass correlation (ICC) of 0.82 (95% CI 0.710-0.894,p<0.001), as well as EF by RTTP (ICC 0.88, 95% CI 0.801–0.930,p<0.001), without statistically significant difference between the two methods (p=0.279). Conclusion : Estimation of LV volumes and EF by RTTP method showed higher correlation than BPS with 3D-echocardiography, in a population of STEMI patients. As an accurate LVEF estimation is of high relevance for its potential to alter clinical decision pathways, this data points to the usefulness of the RTTP method, especially in myocardial infarction setting.