Comparison of Left Ventricular Ejection Fraction Measurements by Echocardiography and Contrast Ventriculography: A Study on a Large Hospitalized Population

Background: The evaluation of the left ventricular ejection fraction (LVEF) is important for predicting mortality and identifying high-risk patients. We aimed to identify factors affecting the variation in the LVEF measurement via echocardiography and contrast left ventriculography (CVG). Methods: A total of 4422 patients (mean age=59.0±10.52 y, range=22–88) who underwent echocardiography and CVG within the same hospitalization period (0- to 14-day intervals) were included. Data were obtained from the Echocardiography Data Bank and the Coronary Angiography Data Bank in Tehran Heart Center. Results: The correlation between the estimation of the EF by echocardiography and CVG was good (r=0.716); however, there was no point-by-point agreement. In 21.5% of the patients, echocardiography and CVG estimated the EF equally, and a difference greater than 20% was found in 1.8% of the patients. The differences between the 2 measurements were remarkable either in the patients with EFs greater than 50% or in those with EFs of 50% or less by CVG (59.71±3.72 by CVG vs 55.96±7.57% by echocardiography in EFs>50% and 40.69±8.96 by CVG vs 43.90±10.71% by echocardiography in EFs≤50%). By linear regression analysis, the presence of pathologic Q wave, atrial fibrillation and left bundle branch block, moderate and severe mitral regurgitation, increased LV size, and increased interventricular septal diameter resulted in a higher EF value via CVG, whereas in those with EFs of 50% or less, the EF by echocardiography was higher. No effect of time gap between the measurements was found. Conclusions: According to our study, the EF measurements obtained by echocardiography and CVG varied on an individual basis. The level of the EF was the most important factor correlating with the difference between the measurements by the methods.