SPC365

Echocardiographic determination of LVEF in patients with a poor acoustic window

Session: CO 20 - Imagem na IC e Doença Coronária
Speaker: José Lopes De Almeida

Congress: CPC 2021
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: José Lopes De Almeida; j. Almeida; s. Martinho; a. Freitas; c. Ferreira; j. Rosa; g. Campos; r. Martins; m. Ferreira; l. Gonçalves
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background: </span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Left ventricular ejection fraction (LVEF) is the most commonly used clinical measure of left ventricular systolic function. The Simpson method is the currently recommended 2D method to assess LVEF by expert committee consensus. </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">This method requires tracings of the blood-tissue interface in the apical four- and two-chamber views. However, in several patients, it is not possible to acquire all the classic echocardiographic views, and this is especially true in critically ill patients. We propose a new method of LVEF estimation using information from parasternal or subcostal views, for those patients in which the Simpson method cannot be applied.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: </span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">We created a method that estimates LVEF based on systolic and diastolic basal, mid and apical short axis areas and ventricle length, acquired in parasternal or subcostal views. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">We retrospectively applied our method to 20 patients who had an echocardiogram followed by a cardiac magnetic resonance (cMRI), and compared LVEF calculated between cMRI and echocardiogram. cMRI LVEF was estimated based on Simpson disk summation method using short-axis cine steady-state free precession images. Echocardiogram LVEF was estimated with both the standard method &ndash; Simpson method &ndash; and the proposed method. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Our population had an average age of 64 (&plusmn; 12) years and 35% of female patients. 6 patients had no significant cardiac structural disease, 4 patients had coronary heart disease, 4 patients had familiar hypertrophic myocardiopathy, 2 patients had cardiac amyloidosis, 1 patient had an atrial septal defect, 1 patient had cardiac sarcoidosis, 1 patient had dilated familiar cardiomyopathy and 1 patient had acute myocarditis. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">LVEF calculated through&nbsp;the proposed method showed a significant correlation with LEVF calculated with the Simpson echocardiographic method (R=0.83, 0.61-0.93, p&lt;0.01).&nbsp;Both our new method (R=0.65, 0.28-0.85, p&lt;0.01)&nbsp;and the Simpson echocardiographic method (R=0.70, 0.37-0.87, p&lt;0.01)&nbsp; correlated moderately with LVEF calculated by cMRI, which is in accordance with previous literature. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion:</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">We show the proof-of-concept of a new method for estimating LVEF by 2D echocardiogram that does not require measurements in the apical views. After validation, this method may become an alternative for estimating LVEF, especially for patients with more challenging acoustic windows where it is not possible to acquire the classic 2D echocardiographic views.&nbsp; </span></span></span></span></p>