Reliability of estimating left ventricular ejection fraction in clinical routine: a validation study of the SWEDEHEART registry
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Key result
SWEDEHEART-reported LVEF shows good agreement with independent re-evaluations but underestimates subnormal function.
- AC2 0.76
- 95% CI 0.69-0.84
- n=130
Why the study?
LVEF is widely used for outcome prediction and treatment guidance in ACS, but the reliability of LVEF values reported to the nationwide SWEDEHEART registry was unknown.
Is the LVEF reported to the SWEDEHEART registry reliable compared to independent core lab re-evaluation in patients with ACS?
Population
130 ACS patients from three hospitals in Sweden
Comparison
LVEF reported to SWEDEHEART vs independent re-evaluation using modified biplane Simpson method
Design
Validation study
Authors
Discussion
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Member takes
Implication
Supports cautious registry LVEF use in ACS; leaves open accuracy for subnormal values in observational research.
Study Design
Type
Observational (n=130)
Blinding
Blinded reviewers
Multicenter
Yes
Structured PICO
Is the LVEF reported to the SWEDEHEART registry reliable compared to independent core lab re-evaluation in patients with ACS?
P
Population
130 patients hospitalized with acute coronary syndrome (ACS) in Sweden, median age 65, 76% male.
I
Intervention
Independent re-evaluation of LVEF using the modified biplane Simpson method by two blinded reviewers.
C
Comparator
LVEF categorized and reported to the SWEDEHEART registry during routine clinical care.
O
Outcome
Agreement between reported and re-evaluated LVEF assessed using Gwet's AC2 statistics.surrogate
Main Result
Effect estimate: AC2 0.76 (95% CI 0.69-0.84)
SWEDEHEART registry LVEF assessments show good overall agreement with independent core lab re-evaluations, though there is a tendency to underestimate LVEF in patients with borderline function.
Limitations
- Registry LVEF was not validated against patient records, so manual misclassification errors cannot be accounted for.
- The reference method was based on 2D echocardiographic raw data rather than gold-standard modalities like CMR or CCT.
- Patients were included from only three university hospitals, which may limit the nationwide representativeness of the sample.
- Not validated in relation to patient records
- Sample from three university hospitals may not represent all Swedish hospitals
Cite This Study
Lenell et al. (2022) conducted an observational in Acute coronary syndrome (n=130). SWEDEHEART registry LVEF assessment vs. Independent re-evaluation using modified biplane Simpson method was evaluated on Agreement between reported and re-evaluated LVEF (Gwet's AC2) (AC2 0.76, 95% CI 0.69-0.84). SWEDEHEART-reported left ventricular ejection fraction showed good agreement with independent re-evaluations (AC2 0.76), although the registry tended to underestimate LVEF in patients with subnormal function.
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