Key result
The 16-Segment Regional Wall Motion Score Index for calculating LVEF correlated strongly with cardiac magnetic resonance (r=0.916, P<0.001) and did not overestimate LVEF unlike Simpson's rule.
Why the study?
Does the 16-Segment Regional Wall Motion Score Index (RWMSI) accurately calculate LVEF compared to CMR and Simpson's rule in patients undergoing 2D echocardiography?
Observational (n=110)
Does the 16-Segment Regional Wall Motion Score Index (RWMSI) accurately calculate LVEF compared to CMR and Simpson's rule in patients undergoing 2D echocardiography?
Effect estimate: r = 0.916
p-value: p=< 0.001
RWMSI provides a more accurate and reliable alternative to Simpson's rule for calculating LVEF by 2D echocardiography when compared to the CMR reference standard.
AIMS: Accurate calculation of left ventricular ejection fraction (LVEF) is important for diagnostic, prognostic and therapeutic reasons. Cardiac magnetic resonance (CMR) is the reference standard for LVEF calculation, followed by real time three-dimensional echocardiography (RT3DE). Limited availability of CMR and RT3DE leaves Simpson's rule as the two-dimensional echocardiography (2DE) standard by which LVEF is calculated. We investigated the accuracy of the 16-Segment Regional Wall Motion Score Index (RWMSI) as an alternative method for calculating LVEF by 2DE and compared this to Simpson's rule and CMR. METHODS AND RESULTS: The 2D echocardiograms of 110 patients were studied (LVEF range: 7-74%); 57 of these underwent CMR. A RWMS was applied, based on the consensus opinion of two experienced cardiologists, to each of 16 American Heart Association myocardial segments (RWMSI: hyperkinesis = 3; normal regional contraction = 2; mild hypokinesis = 1.25; severe hypokinesis = 0.75; akinesis = 0; dyskinesis =-1). LVEF was calculated by: LVEF(%) =Σ(16segRWMS)/16×30. LVEF was calculated by Simpson's rule and CMR using standard methods. Results were correlated against CMR. Intertechnique agreement was examined. A P value of<0.05 was considered significant. RWMSI-LVEF correlated strongly with Biplane Simpson's rule (P< 0.001, r = 0.915). RWMSI-LVEF had a strong correlation to CMR (P < 0.001, r = 0.916); Simpson's rule-LVEF had a moderate correlation to CMR (P< 0.001, r = 0.647). In patients with LV dysfunction (EF < 55%), on linear regression analysis, RWMSI-LVEF had a better correlation with CMR than Simpson's rule. Further more Simpson's rule overestimated LVEF compared to CMR (mean difference: -6.12 ± 16.44, P = 0.002) whereas RWMSI did not (mean difference: 2.58 ± 14.80, P = NS). CONCLUSION: RWMSI-LVEF correlates strongly with CMR with good intertechnique agreement. In centers where CMR and RT3DE are not readily available, the use by experienced individuals, of the RWMSI for calculating LVEF may be a more simple, accurate, and reliable alternative to Simpson's rule.
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Duncan et al. (2011) conducted an observational in Left ventricular ejection fraction assessment (n=110). 16-Segment Regional Wall Motion Score Index (RWMSI) vs. Biplane Simpson's rule and Cardiac Magnetic Resonance (CMR) was evaluated on Correlation of LVEF calculated by RWMSI with CMR (r = 0.916, p=< 0.001). The 16-Segment Regional Wall Motion Score Index for calculating LVEF correlated strongly with cardiac magnetic resonance (r=0.916, P<0.001) and did not overestimate LVEF unlike Simpson's rule.
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