Abstract
Background: Echocardiographic automated border detection (ABD) provides on‐line, beat‐to‐beat estimation of left ventricular (LV) ejection fraction (EF). Sensitivity and specificity of using ABD‐EF for diagnosing LV dysfunction in routine clinical situations have not been previously studied.
Hypothesis: Analysis of ABD‐EF data based on receiver operating characteristic (ROC) should provide useful information about sensitivity and specificity for clinical diagnosis of LV function based on ABD‐EF.
Methods: The study group included 50 consecutive patients with EF measured by both ABD and radionuclide ventriculography (RVG). ABD‐EF was recorded for 25 consecutive heart beats in the apical four‐chamber view. Data were analyzed statistically by linear regression, Bland‐Altman plot, and ROC. In ROC analysis, abnormal LV function was defined RVG‐EF ≤ 40%.
Results: ABD and RVG showed a moderate correlation in the EF measurements: slope=0.93, intercept=17%, r=0.79 (n = 50). Interbeat variability in ABD was diminished by averaging consecutive beats; standard error of estimate (SEE) decreased from 15.6% without averaging to 12.5% with 25‐beat averaging. Bland‐Altman analysis indicated that ABD‐EF compared unfavorably with RVG‐EF, with limits of agreement from ‐11% to 39%. ABD‐EF showed a systematic overestimation (p<0.005), which was compensated by increasing the threshold for abnormal ABD‐EF to 56%. With the optimized threshold, ABD‐EF provided 89% sensitivity and 89% specificity (85% overall diagnostic accuracy) for diagnosing abnormal LV function.
Conclusion: This study explored the limitations of on‐line echocardiographic measurement of EF in a clinical setting and provided useful data for assessing interbeat variability, sensitivity, and specificit.
Keywords: echocardiography; automated border detection; interbeat variability; sensitivity and specificity; Bland‐Altman plot, receiver operating characteristic
Full Text
The Full Text of this article is available as a PDF (615.9 KB).
References
- 1. Pearlman AS, Stevenson JG, Baker DW: Doppler echocardiography applications and future directions. Am J Cardiol 1980; 46: 1256–1262 [DOI] [PubMed] [Google Scholar]
- 2. Popp RL: The challenge of quality versus quantity in echocardiography. J Am Soc Echocardiogr 1992; 5: 1–4 [DOI] [PubMed] [Google Scholar]
- 3. Feigenbaum H: Role of echocardiography in acute myocardial infarction. Am J Cardiol 1990; 66: 17H–22H [DOI] [PubMed] [Google Scholar]
- 4. Vandenberg BF, Rath L, Shoup TA, Kerber RE, Collins SM, Skorton DJ: Cyclic variation of ultrasound backscatter in normal myocardium is view‐dependent: Clinical studies with a real‐time backscatter imaging system. J Am Soc Echocardiogr 1991; 4: 308–314 [DOI] [PubMed] [Google Scholar]
- 5. Perez JE, Waggoner AD, Barzilai B, Melton HE Jr, Miller JG, Sobel BE: On‐line assessment of ventricular function by automated boundary detection and ultrasonic backscatter imaging. J Am Coll Cardiol 1992; 19: 313–320 [DOI] [PubMed] [Google Scholar]
- 6. Vandenberg BF, Rath LS, Stuhlmuller P, Melton HE, Skorton DJ: Estimation of left ventricular cavity area with an on‐line, semiautomated echocardiographic edge detection system. Circulation 1992; 86: 159–166 [DOI] [PubMed] [Google Scholar]
- 7. Ashburn WL, Schelbert HR, Verba JW: Left ventricular ejection fraction—a review of several radionuclide angiographic approaches using the scintillation camera. Progr Cardiovasc Dis 1978; 20: 267–284 [DOI] [PubMed] [Google Scholar]
- 8. Bednarz JE, Marcus RH, Lang RM: Technical guidelines for performing automated border detection studies. J Am Soc Echocardiogr 1995; 8: 293–305 [DOI] [PubMed] [Google Scholar]
- 9. Gorcsan J III, Lazar JM, Schulman DS, Follansbee WP: Comparison of left ventricular function by echocardiographic automated border detection and by radionuclide ejection fraction. Am J Cardiol 1993; 72: 810–815 [DOI] [PubMed] [Google Scholar]
- 10. Lindower PD, Rath L, Preslar J, Burns TL, Rezai K, Vandenberg BF: Quantification of left ventricular function with an automated border detection system and comparison with radionuclide ventriculography. Am J Cardiol 1994; 73: 195–199 [DOI] [PubMed] [Google Scholar]
- 11. Yvorchuk K, Davies RA, Chan K‐L: Measurement of left ventricular ejection fraction by acoustic quantification and comparison with radionuclide angiography. Am J Cardiol 1994; 74: 1052–1056 [DOI] [PubMed] [Google Scholar]
- 12. Martin RP: Real‐time ultrasound quantification of ventricular function: Has the eyeball been replaced or will the subjective become objective? J Am Coll Cardiol 1992; 19: 321–323 [DOI] [PubMed] [Google Scholar]
- 13. Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310 [PubMed] [Google Scholar]
- 14. Moyé LA, Pfeffer MA, Braunwald E, SAVE Investigators : Rationale, design and baseline characteristics of the survival and ventricular enlargement trial. Am J Cardiol 1991; 68: 70D–79D [DOI] [PubMed] [Google Scholar]
- 15. Sun Y, Gobikrishna A, Hadid A, Lucariello RJ, Chiaramida SA: Software for receiver operating characteristic (ROC) analysis and evaluation of sensitivity and specificity (abstr). J Am Coll Cardiol 1997; 29: 335A [Google Scholar]
- 16. Marcus RH, Bednarz J, Coulden R, Shroff S, Lipton M, Lang RM: Ultrasonic backscatter system for automated on‐line endocardial boundary detection: Evaluation by ultrafast computed tomography. J Am Coll Cardiol 1993; 22: 839–847 [DOI] [PubMed] [Google Scholar]
- 17. Hammermeister KE, DeRouen TA, Dodge HT: Variables predictive of survival in patients with coronary disease. Circulation 1979; 59: 421–430 [DOI] [PubMed] [Google Scholar]
- 18. Ahnve S, Gilpin E, Henning H, Curtis G, Collins D, Ross J Jr: Limitations and advantages of the ejection fraction for defining high risk after acute myocardial infarction. Am J Cardiol 1986; 58: 872–878 [DOI] [PubMed] [Google Scholar]
- 19. Perez JE, Miller JG, Wickline SA, Holland MR, Waggoner AD, Barzilai B, Sobel BE: Quantitative ultrasonic imaging: Tissue characterization and instantaneous quantification of cardiac function. Am J Cardiol 1992; 69: 104H–111H [DOI] [PubMed] [Google Scholar]
- 20. Perez JE, Klein SC, Prater DM, Fraser CE, Cardona H, Waggoner AD, Holland MR, Miller JG, Sobel BE: Automated, on‐line quantification of left ventricular dimensions and function by echocardiography with backscatter imaging and lateral gain compensation. Am J Cardiol 1992; 70: 1200–1205 [DOI] [PubMed] [Google Scholar]
- 21. Katz WE, Gasior TA, Gorcsan J III: Utility and limitations of biplane transesophageal echocardiographic automated border detection for estimation of left ventricular stroke volume and cardiac output. Am Heart J 1994; 128: 389–396 [DOI] [PubMed] [Google Scholar]