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. 1999 Aug;82(2):192–198. doi: 10.1136/hrt.82.2.192

Echocardiographic assessment of ejection fraction in left ventricular hypertrophy

B Wandt 1, L Bojo 1, K Tolagen 1, B Wranne 1
PMCID: PMC1729121  PMID: 10409535

Abstract

OBJECTIVE—To investigate the value of Simpson's rule, Teichholz's formula, and recording of mitral ring motion in assessing left ventricular ejection fraction (EF) in patients with left ventricular hypertrophy.
DESIGN—Left ventricular ejection fraction calculated by Simpson's rule and by Techholz's formula and estimated by mitral ring motion was compared with values obtained by radionuclide angiography.
SETTING—Secondary referral centre.
PATIENTS—16 patients with left ventricular hypertrophy and a clinical diagnosis of hypertrophic cardiomyopathy or hypertension.
RESULTS—Calculation by Teichholz's formula overestimated left ventricular ejection fraction by 10% (p = 0.002) and estimation based on mitral ring motion—that is, long axis measurements—underestimated ejection fraction by 19% (p = 0.002), without significant correlation between ring motion and ejection fraction. There was no significant difference between mean values of ejection fraction calculated by Simpson's rule and measured by the reference method, but a considerable scatter about the regression line with a standard error of the estimate of 9.3 EF%.
CONCLUSIONS—In patients with left ventricular hypertrophy the ejection fraction, calculated by Teichholz's formula or Simpson's rule, is a poor measure of left ventricular function. When mitral ring motion is used for the assessment in these patients the function should be expressed in ways other than by the ejection fraction.


Keywords: left ventricular hypertrophy; ejection fraction; mitral ring motion; atrioventricular plane displacement

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Figure 1  .

Figure 1  

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Correlation between ejection fraction (EF) by radionuclide angiography and EF by Teichholz's formula (A) and by mitral ring motion (MRM) × 5 (B), and by Simpson's rule (C). Empty squares, patients with hypertension; shaded squares, patients with hypertrophic cardiomyopathy.

Figure 2  .

Figure 2  

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The correlation between mitral ring motion (MRM) and ejection fraction in patients with left ventricular hypertrophy. Empty squares, patients with hypertension; shaded squares, patients with hypertrophic cardiomyopathy.

Figure 3  .

Figure 3  

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Bland and Altman diagrams showing difference against mean for ejection fraction (EF) calculated by Teichholz's formula (A) and by Simpson's rule (B), compared with values obtained by radionuclide angiography (RNA).

Figure 4  .

Figure 4  

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The correlation between mitral ring motion (MRM) and ejection fraction (EF%) in four previous studies, in patients with hypertrophy in the present study, and EF% = MRM (mm) × 5. (1) Alam, 199011: EF (%) = 5.0 × MRM (mm) − 5.6; r = 0.82; (2) Pai, 199119: EF (%) = 4.4 × MRM (mm) + 1.5; r = 0.95; (3) Alam, 199118: EF (%) = 5.5 × MRM (mm) − 5; r = 0.87; (4) Alam, 199217: EF (%) = 4.4 × MRM (mm) + 11.5; r = 0.89; (5) EF (%) = 5 × MRM (mm); H, patients with left ventricular hypertrophy (r = 0.12, NS).

Figure 5  .

Figure 5  

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Schematic illustration of the four sites of the mitral ring where measurements are obtained for calculation of mitral ring motion.

Figure 6  .

Figure 6  

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Schematic figure of the different parts of M mode recording of mitral ring motion.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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