Lack of Agreement Between Left Ventricular Volumes and Ejection Fraction Determined by Two‐Dimensional Echocardiography and Contrast Cineangiography in Postinfarction Patients

Objective: To assess the agreement between left ventricular (LV) volumes and ejection fraction (EF) determined by two‐dimensional echocardiography (2‐D echo) and by cineangiography in postinfarction patients. Design: LV end‐diastolic and end‐systolic volumes indexed (EDVI and ESVI) to body surface area as well as EF were determined by both methods in all patients. Setting: Multicenter trial conducted in five university hospitals. Patients: 63 patients, 61 male, two female, mean age 55.5 ± 10.4 years, suffering from a recent myocardial infarction. Eighty‐one pairs of measurements were available. Methods: The results of biplane 2‐D echo measures, using apical four‐chamber (4C) and two‐chamber (2C) views were compared to those of a 30° right anterior oblique cineangiography projection, using either the apical method of discs or the area‐length 2‐D echo method. Moreover, eyeball EF was estimated at 2‐D echo and cineangiography, and was compared to the conventional methods. The agreement between results was assessed by the Bland and Altman method. Results: The agreement between 2‐D echo and cineangiography results was poor. Mean differences (MD) were −21.8 (EDVI, ml/m2), −9.5 (ESVI, ml/m2), and −0.9 (EF, %), respectively for 2‐D echo method of discs versus cineangiography, and −23.2, −9.3, and −5.7 for area‐length 2‐D echo versus cineangiography. For EF (%), MD was −3.6 for eyeball cineangiography versus cineangiography, −1.3 for eyeball 2‐D echo versus method of discs, and + 0.30 for eyeball 2‐D echo versus area‐length 2‐D echo, respectively. Two‐dimensional echo is likely to underestimate LV volumes compared to cineangiography, especially for largest volumes. Even for EF, discrepancies are large, with a lack of agreement of 21%–25% between conventional methods, but agreement is better between eyeball EF and usual methods. Conclusions: Even with modern echocardiographic devices, agreement between 2‐D echo and cineangiography‐derived LV volumes and EF remains moderate, and both methods must not be considered interchangeable in clinical practice.