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European Radiology
Published in: European Radiology 1/2020

Open Access 01-01-2020 | Echocardiography | Cardiac

Baseline LV ejection fraction by cardiac magnetic resonance and 2D echocardiography after ST-elevation myocardial infarction – influence of infarct location and prognostic impact

Authors: Johannes P. Schwaiger, Sebastian J. Reinstadler, Christina Tiller, Magdalena Holzknecht, Martin Reindl, Agnes Mayr, Ivo Graziadei, Silvana Müller, Bernhard Metzler, Gert Klug

Published in: European Radiology | Issue 1/2020

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Abstract

Objectives

The comparability of left ventricular ejection fraction (LVEF) measurements by cardiac magnetic resonance (CMR) and 2D echocardiography (2DE) early after ST-elevation myocardial infarction (STEMI) remains unclear.

Methods

In this study, LVEF measured by CMR and 2DE (Simpson’s method) were compared in 221 patients after STEMI treated by primary percutaneous coronary intervention. 2DE image quality was systematically assessed and studies reported by an accredited examiner. Intermodality agreement was assessed by the Bland–Altman method. Major adverse cardiac events (MACE) were defined as the composite of death, myocardial infarction or hospitalisation for heart failure. Patients were followed up for a median of 40.9 months (IQR 28.1–56).

Results

After non-anterior STEMI, LVEF measurements by 2DE (single and biplane) were consistently underestimated in comparison to CMR (CMR 55.7 ± 9.5% vs. 2DE-4CV 49 ± 8.2% (p = 0.06), 2DE-2CV 52 ± 8% (p < 0.001), 2DE-biplane 53.5 ± 7.1% (p = 0.01)). After anterior STEMI, there was no significant difference in LVEF measurements by 2DE and CMR with acceptable limits of agreement (CMR 49 ± 11% vs. 2DE-4CV 49 ± 8.2% (p = 0.8), 2DE-2CV 49 ± 9.2% (p = 0.9), 2DE-biplane 49.6 ± 8% (p = 0.5)). In total, 15% of patients experienced a MACE during follow-up. In multivariate Cox regression analysis, reduced LVEF (< 52%) as assessed by either 2DE or CMR was predictive of MACE (2DE HR = 2.57 (95% CI 1.1–6.2), p = 0.036; CMR HR = 2.51 (95% CI 1.1–5.7), p = 0.028).

Conclusions

At baseline after non-anterior STEMI, 2D echocardiography significantly underestimated LVEF in comparison to CMR, whereas after anterior infarction, measurements were within acceptable limits of agreement. Both imaging modalities offered similar prognostic values when a reduced LVEF < 52% was applied.

Key Points

• After non-anterior STEMI, 2D-echocardiography significantly underestimated LVEF compared with cardiac MRI
• An ejection fraction of < 52% in the acute post-infarct period by both 2D echocardiography and CMR offered similar prognostic values
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Metadata
Title
Baseline LV ejection fraction by cardiac magnetic resonance and 2D echocardiography after ST-elevation myocardial infarction – influence of infarct location and prognostic impact
Authors
Johannes P. Schwaiger
Sebastian J. Reinstadler
Christina Tiller
Magdalena Holzknecht
Martin Reindl
Agnes Mayr
Ivo Graziadei
Silvana Müller
Bernhard Metzler
Gert Klug
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06316-3

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