Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;112(1):68-74.
doi: 10.1007/s00392-022-02031-0. Epub 2022 May 17.

Reliability of estimating left ventricular ejection fraction in clinical routine: a validation study of the SWEDEHEART registry

Joel Lenell  1 , Bertil Lindahl  2 , Per Karlsson  3 , Gorav Batra  2 , David Erlinge  4 , Tomas Jernberg  5 , Jonas Spaak  5 , Tomasz Baron  2
Affiliations

Reliability of estimating left ventricular ejection fraction in clinical routine: a validation study of the SWEDEHEART registry

Joel Lenell et al. Clin Res Cardiol. 2023 Jan.

Abstract

Objective: Patients hospitalized with acute coronary syndrome (ACS) in Sweden routinely undergo an echocardiographic examination with assessment of left ventricular ejection fraction (LVEF). LVEF is a measurement widely used for outcome prediction and treatment guidance. The obtained LVEF is categorized as normal (> 50%) or mildly, moderately, or severely impaired (40-49, 30-39, and < 30%, respectively) and reported to the nationwide registry for ACS (SWEDEHEART). The purpose of this study was to determine the reliability of the reported LVEF values by validating them against an independent re-evaluation of LVEF.

Methods: A random sample of 130 patients from three hospitals were included. LVEF re-evaluation was performed by two independent reviewers using the modified biplane Simpson method and their mean LVEF was compared to the LVEF reported to SWEDEHEART. Agreement between reported and re-evaluated LVEF was assessed using Gwet's AC2 statistics.

Results: Analysis showed good agreement between reported and re-evaluated LVEF (AC2: 0.76 [95% CI 0.69-0.84]). The LVEF re-evaluations were in agreement with the registry reported LVEF categorization in 86 (66.0%) of the cases. In 33 (25.4%) of the cases the SWEDEHEART-reported LVEF was lower than re-evaluated LVEF. The opposite relation was found in 11 (8.5%) of the cases (p < 0.005).

Conclusion: Independent validation of SWEDEHEART-reported LVEF shows an overall good agreement with the re-evaluated LVEF. However, a tendency towards underestimation of LVEF was observed, with the largest discrepancy between re-evaluated LVEF and registry LVEF in subjects with subnormal LV-function in whom the reported assessment of LVEF should be interpreted more cautiously.

Keywords: Echocardiography; LVEF; Registry; SWEDEHEART; Validation.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flow chart illustrating patient selection
Fig. 2
Fig. 2
a A scatter plot illustrating inter-observer variability between the two reviewers. The dotted lines mark the cut-off values defining LVEF categories in SWEDEHEART. b Bland–Altman plot illustrating the difference between the reviewers’ measurements to their mean. Orange line = mean difference, Red lines = mean difference ± 1.96* standard deviation of the difference
Fig. 3
Fig. 3
Combined boxplot and dotplot with distribution of the reassessed LVEF in LVEF categories according to SWEDEHEART. Middle line = median; Box = interquartile range (IQR); Whiskers = lowest and maximum LVEF excluding outliers; Circle outside whiskers = mild outliers; asterisk in circle = severe outliers
See this image and copyright information in PMC

References

    1. Collet J-P, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2021;42(14):1289–1367. doi: 10.1093/eurheartj/ehaa575. - DOI - PubMed
    1. Thavendiranathan P, et al. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes. J Am Coll Cardiol. 2013;61(1):77–84. doi: 10.1016/j.jacc.2012.09.035. - DOI - PubMed
    1. Baron T, et al. Test–retest reliability of new and conventional echocardiographic parameters of left ventricular systolic function. Clin Res Cardiol. 2019;108(4):355–365. doi: 10.1007/s00392-018-1363-7. - DOI - PMC - PubMed
    1. Cole GD, et al. Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation. Int J Cardiovasc Imaging. 2015;31(7):1303–1314. doi: 10.1007/s10554-015-0659-1. - DOI - PMC - PubMed
    1. McGowan JH, Cleland JGF. Reliability of reporting left ventricular systolic function by echocardiography: a systematic review of 3 methods. Am Heart J. 2003;146(3):388–397. doi: 10.1016/S0002-8703(03)00248-5. - DOI - PubMed

LinkOut - more resources