Reliability of estimating left ventricular ejection fraction in clinical routine : a validation study of the SWEDEHEART registry
Lenell, Joel ; Lindahl, Bertil ; Karlsson, Per ; Batra, Gorav ; Erlinge, David LU
; Jernberg, Tomas
; Spaak, Jonas
and Baron, Tomasz
(2023)
In Clinical Research in Cardiology
112(1).
p.68-74
- Abstract
Objective: Patients hospitalized with acute coronary syndrome (ACS) in Sweden routinely undergo an echocardiographic examination with assessment of left ventricular ejection fraction (LVEF). LVEF is a measurement widely used for outcome prediction and treatment guidance. The obtained LVEF is categorized as normal (> 50%) or mildly, moderately, or severely impaired (40–49, 30–39, and < 30%, respectively) and reported to the nationwide registry for ACS (SWEDEHEART). The purpose of this study was to determine the reliability of the reported LVEF values by validating them against an independent re-evaluation of LVEF. Methods: A random sample of 130 patients from three hospitals were included. LVEF re-evaluation was performed by two... (More)
Objective: Patients hospitalized with acute coronary syndrome (ACS) in Sweden routinely undergo an echocardiographic examination with assessment of left ventricular ejection fraction (LVEF). LVEF is a measurement widely used for outcome prediction and treatment guidance. The obtained LVEF is categorized as normal (> 50%) or mildly, moderately, or severely impaired (40–49, 30–39, and < 30%, respectively) and reported to the nationwide registry for ACS (SWEDEHEART). The purpose of this study was to determine the reliability of the reported LVEF values by validating them against an independent re-evaluation of LVEF. Methods: A random sample of 130 patients from three hospitals were included. LVEF re-evaluation was performed by two independent reviewers using the modified biplane Simpson method and their mean LVEF was compared to the LVEF reported to SWEDEHEART. Agreement between reported and re-evaluated LVEF was assessed using Gwet’s AC2 statistics. Results: Analysis showed good agreement between reported and re-evaluated LVEF (AC2: 0.76 [95% CI 0.69–0.84]). The LVEF re-evaluations were in agreement with the registry reported LVEF categorization in 86 (66.0%) of the cases. In 33 (25.4%) of the cases the SWEDEHEART-reported LVEF was lower than re-evaluated LVEF. The opposite relation was found in 11 (8.5%) of the cases (p < 0.005). Conclusion: Independent validation of SWEDEHEART-reported LVEF shows an overall good agreement with the re-evaluated LVEF. However, a tendency towards underestimation of LVEF was observed, with the largest discrepancy between re-evaluated LVEF and registry LVEF in subjects with subnormal LV-function in whom the reported assessment of LVEF should be interpreted more cautiously.
(Less)
- author
- Lenell, Joel
; Lindahl, Bertil
; Karlsson, Per
; Batra, Gorav
; Erlinge, David
LU
; Jernberg, Tomas
; Spaak, Jonas
and Baron, Tomasz
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Echocardiography, LVEF, Registry, SWEDEHEART, Validation
- in
- Clinical Research in Cardiology
- volume
- 112
- issue
- 1
- pages
- 68 - 74
- publisher
- Steinkopff
- external identifiers
-
- pmid:35581481
- scopus:85130433384
- ISSN
- 1861-0684
- DOI
- 10.1007/s00392-022-02031-0
- language
- English
- LU publication?
- yes
- id
- 0161bc26-647e-4cd3-918e-8009023718ce
- date added to LUP
- 2023-01-20 12:13:07
- date last changed
- 2024-04-18 18:15:48
@article{0161bc26-647e-4cd3-918e-8009023718ce,
abstract = {{<p>Objective: Patients hospitalized with acute coronary syndrome (ACS) in Sweden routinely undergo an echocardiographic examination with assessment of left ventricular ejection fraction (LVEF). LVEF is a measurement widely used for outcome prediction and treatment guidance. The obtained LVEF is categorized as normal (> 50%) or mildly, moderately, or severely impaired (40–49, 30–39, and < 30%, respectively) and reported to the nationwide registry for ACS (SWEDEHEART). The purpose of this study was to determine the reliability of the reported LVEF values by validating them against an independent re-evaluation of LVEF. Methods: A random sample of 130 patients from three hospitals were included. LVEF re-evaluation was performed by two independent reviewers using the modified biplane Simpson method and their mean LVEF was compared to the LVEF reported to SWEDEHEART. Agreement between reported and re-evaluated LVEF was assessed using Gwet’s AC2 statistics. Results: Analysis showed good agreement between reported and re-evaluated LVEF (AC2: 0.76 [95% CI 0.69–0.84]). The LVEF re-evaluations were in agreement with the registry reported LVEF categorization in 86 (66.0%) of the cases. In 33 (25.4%) of the cases the SWEDEHEART-reported LVEF was lower than re-evaluated LVEF. The opposite relation was found in 11 (8.5%) of the cases (p < 0.005). Conclusion: Independent validation of SWEDEHEART-reported LVEF shows an overall good agreement with the re-evaluated LVEF. However, a tendency towards underestimation of LVEF was observed, with the largest discrepancy between re-evaluated LVEF and registry LVEF in subjects with subnormal LV-function in whom the reported assessment of LVEF should be interpreted more cautiously.<br/></p>}},
author = {{Lenell, Joel and Lindahl, Bertil and Karlsson, Per and Batra, Gorav and Erlinge, David and Jernberg, Tomas and Spaak, Jonas and Baron, Tomasz}},
issn = {{1861-0684}},
keywords = {{Echocardiography; LVEF; Registry; SWEDEHEART; Validation}},
language = {{eng}},
number = {{1}},
pages = {{68--74}},
publisher = {{Steinkopff}},
series = {{Clinical Research in Cardiology}},
title = {{Reliability of estimating left ventricular ejection fraction in clinical routine : a validation study of the SWEDEHEART registry}},
url = {{http://dx.doi.org/10.1007/s00392-022-02031-0}},
doi = {{10.1007/s00392-022-02031-0}},
volume = {{112}},
year = {{2023}},
}