A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography

Abstract

A new method to determine left ventricular (LV) ejection fraction (EF) with wide-angle, two-dimensional echocardiography (2-D echo) has been developed using the parasternal long-axis, apical four-chamber and apical long-axis views. End-diastolic and end-systolic measurements of LV short axes at the base and mid-LV cavity in the parasternal long-axis view and at the upper, middle and lower thirds of the cavity in the apical views are made, from which an averaged minor axis at end-diastolic and at end-systole is calculated. Fractional shortening of the LV long axis (delta L) is estimated from apical contraction. Satisfactory 2-D echoes were obtained in 55 of 58 nonselected patients (all three views in 32 patients, two views in 22 and one view in one); 42 of 55 patients had coronary artery disease. EF by 2-D echo was compared with EF by gated cardiac blood pool imaging in all patients (r = 0.927, SEE = 6.7%) and to EF by single-plane cineangiography (angio) in 35 of 55 patients (r = 0.913, SEE = 7.4%). LV dyssynergy was frequently present and involved the apex in 29 of 55 patients. Using angio as the standard for evaluating wall motion at the apex, 2-D echo was 100% sensitive and specific in detecting abnormal apical wall motion. We conclude that EF can be determined accurately with 2-D echo in a large group of patients with and without dyssynergy by a simple method that eliminates the need for planimetry or computer assistance.