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Cardiovascular Ultrasound
Published in: Cardiovascular Ultrasound 1/2019

Open Access 01-12-2019 | Echocardiography | Research

Impact of a training program incorporating cardiac magnetic resonance imaging on the accuracy and reproducibility of two-dimensional echocardiographic measurements of left ventricular volumes and ejection fraction

Authors: Yosuke Nabeshima, Hidehiro Namisaki, Toshihiro Teshima, Yasuhiko Kurashige, Akiko Kakio, Azusa Fukumitsu, Yutaka Otsuji, Masaaki Takeuchi

Published in: Cardiovascular Ultrasound | Issue 1/2019

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Abstract

Background

Left ventricular (LV) ejection fraction (LVEF) assessed by two-dimensional echocardiography (2DE) is the most widely used parameter for clinical decision-making, but reproducibility and accuracy problems remain. We evaluated the usefulness of a novel training program based on cardiac magnetic resonance (CMR) imaging to obtain more reliable values of 2DE-derived LVEF and LV volumes.

Methods

Fifty-four sonographers from five hospitals independently measured LV volumes and LVEF using the same 2DE images from 15 patients who underwent CMR and 2DE. After receiving a lecture from an expert on how to properly trace the LV endocardium, each sonographer voluntary performed the measurements using the same datasets, and was invited to perform the same analysis for additional patients. The effect of the training intervention was evaluated using the coefficient of variation (CV) and coverage probability (CP).

Results

Before the intervention, the LV volumes were significantly underestimated and the LVEF was significantly overestimated compared to the CMR results; however, these differences were reduced after the intervention. In particular, the CP (0.52 vs. 0.76, p < 0.001) for the LVEF showed significant improvement. However, the degree of improvement differed among institutions, and the CV actually became worse in two hospitals after the intervention. Level of experience and self-practice was associated with the reproducibility after the intervention.

Conclusions

A training program using CMR as a reference improved the accuracy of 2DE-determined LV measurements. Since the degree of improvements differed among hospitals, individualization of training programs and periodical objective evaluation may be required to reduce inter-institutional variability.
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Metadata
Title
Impact of a training program incorporating cardiac magnetic resonance imaging on the accuracy and reproducibility of two-dimensional echocardiographic measurements of left ventricular volumes and ejection fraction
Authors
Yosuke Nabeshima
Hidehiro Namisaki
Toshihiro Teshima
Yasuhiko Kurashige
Akiko Kakio
Azusa Fukumitsu
Yutaka Otsuji
Masaaki Takeuchi
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2019
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/s12947-019-0173-z

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