Comparison of ultrasound and cineangiographic measurements of left ventricular performance in patients with and without wall motion abnormalities

It has been proposed that ultrasound estimation of left ventricular volume, ejection fraction, and the mean rate of circumferential fibre shortening (mean V (CF)) may be inaccurate in patients with abnormalities of left ventricular wall motion. Accordingly, the authors measured left ventricular dimensions by echocardiography in 36 patients undergoing biplane left ventricular cineangiography, 21 of whom had an abnormal pattern of left ventricular wall motion. In 19 instances this was due to coronary artery disease and in 2 cases to primary myocardial disease. In the 15 patients with normal wall motion, the end diastolic volume corrected for body surface area (end diastolic volume index) was normal in all but one instance by both echo and cine, while in the group with abnormal wall motion, 8 had an enlarged end diastolic volume index measured by both techniques, and 10 were normal by both methods; in 3 patients the measurements were discordant. With the exception of 4 patients with abnormal wall motion and 1 with normal wall motion, the ultrasound method separated those patients with a normal from those with a reduced ejection fraction. By contrast, all patients with wall motion abnormalities had depressed left ventricular performance as judged by the mean rate of circumferential fibre shortening (mean V(CF)) calculated either by cineangiography or by echocardiography. It is concluded that echographic assessment of left ventricular volume may be subject to error in individual patients, especially those with an enlarged left ventricular chamber in whom conventional assumptions regarding the ellipsoid shape of the normal left ventricular cavity may not be valid. However, calculation of ejection phase measures of left ventricular performance, especially mean V(CF), the estimation of which does not require any assumptions regarding left ventricular cavity size or shape appears to be valid even in the presence of disordered left ventricular wall motion.