Impact of cardiovascular magnetic resonance assessment of ejection fraction on eligibility for implantable cardioverter defibrillators
© Joshi et al; licensee BioMed Central Ltd. 2011
Published: 2 February 2011
To determine whether cardiovascular magnetic resonance (CMR) for left ventricular ejection fraction (LVEF) assessment changes implantable cardioverter defibrillator (ICD) eligibility when compared with echocardiography.
A markedly reduced LVEF is considered an indication for ICD placement for the primary prevention of sudden cardiac death. However, despite strict LVEF criteria, most guidelines do not specify the technique by which LVEF should be measured.
The study population consisted of patients referred for LVEF measurement by CMR, for consideration of ICD implantation, who also underwent echocardiography within 30 days of the CMR. LVEF was assessed on echocardiography using Simpson’s biplane method. LVEF was determined from CMR based on manual planimetry of SSFP cine images of contiguous left ventricular short axis slices. CMR and echocardiography derived LVEFs were reported by two independent blinded observers.
LVEF Threshold 30 %
Echo LVEF >=30%
Echo LVEF <30%
CMR LVEF >=30 %
CMR LVEF <30 %
Kappa = 0.68
LVEF Threshold 35 %
Echo LVEF >= 35 %
Echo LVEF < 35%
CMR LVEF >=35%
CMR LVEF <35%
Kappa = 0.58
In this cohort of patients being considered for ICD implantation, echocardiography systematically over-estimated LVEF. Using strict LVEF criteria, CMR changed the eligibility for ICD in a substantial proportion of patients, with, in most cases, CMR determining that the patient was ICD eligible when they were not based on echocardiography.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.