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Lookup NU author(s): Dr Richard Peace, Dr Gareth Parry
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2018 Background: Quantification of ventricular performance requires a comprehensive metric which is manageable for patient care and clinical trials. Ejection fraction (EF) has been embraced as an attractive candidate. However, being a dimensionless ratio, EF has serious limitations. Methods: We aim to identify what information is not recognized when limiting the volume-related analysis by exclusively relying on EF. This investigation applies the volume domain concept, relating end-systolic volume (ESV) to end-diastolic volume (EDV). This approach allows graphical identification of the information not covered by EF. Implications for atria, left ventricle (LV) and right ventricle (RV) are investigated in healthy individuals, and cardiac patient groups using various imaging modalities. Results: The Pythagorean theorem indicates that the hypotenuse which relates any {EDV, ESV} combination to EF corresponds with the information not covered by the single metric EF. The impact of the recovered EF companion (EFC) is illustrated in healthy adults (N = 410, LV 2D echocardiography), heart transplant patients (N = 101, LV CT), individuals with heart failure (N = 197, biplane angiocardiography), for the RV with corrected Fallot (N = 124, MRI), diameters for left atrium (N = 49, MRI) and area for right atrium (N = 51, MRI). For any limited EF range we find a spectrum of EFC values, showing that the two metrics contain (partly) independent information, and emphasizing that the sole use of EF only partially conveys the full information available. Conclusions: The EFC is a neglected companion, containing information which is additive to EF. Analysis based on ESV and EDV is preferred over the use of EF.
Author(s): Kerkhof PLM, Merillon JP, Yoo BW, Peace RA, Parry G, Heyndrickx GR, Kuznetsova T, Meijboom LJ, Sprengers RW, Park HK, Handly N
Publication type: Article
Publication status: Published
Journal: International Journal of Cardiology
Year: 2018
Volume: 270
Pages: 237-243
Print publication date: 01/11/2018
Online publication date: 20/06/2018
Acceptance date: 18/06/2018
Date deposited: 16/07/2018
ISSN (print): 0167-5273
ISSN (electronic): 1874-1754
Publisher: Elsevier Ireland Ltd.
URL: https://doi.org/10.1016/j.ijcard.2018.06.074
DOI: 10.1016/j.ijcard.2018.06.074
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