Interobserver agreement and accuracy of bedside estimation of right and left ventricular ejection fraction in acute myocardial infarction

Niels Gadsbøll*, Poul Flemming Høilund-Carlsen, Gert G. Nielsen, Jens Berning, Niels E. Bruun, Poul Stage, Ebbe Hein

*Corresponding author af dette arbejde

    Publikation: Bidrag til tidsskriftArtikelForskningpeer review

    Abstract

    Ninety-eight patients with acute myocardial infarction were examined by 3 clinicians who, independently of each other, gave an estimate of left ventricular (LV) and right ventricular (RV) ejection fraction (EF) in each patient. Their estimates were based on physical examination, chest x-ray, electrocardiogram, patient history and clinical course during admission. Ejection fractions were estimated as belonging to 1 of 4 categories: normal (LVEF ≥0.53, RVEF ≥0.57), mildly reduced (LVEF 0.40 to 0.52, RVEF 0.45 to 0.56), moderately reduced (LVEF 0.30 to 0.39, RVEF 0.35 to 0.44) or severely reduced (LVEF <0.30, RVEF <0.35). Radionuclide ventriculography was carried out immediately after the physical examination. LVEF was correctly estimated in 43% of all examinations, deviated from radionuclide LVEF by 1 LVEF category in 45% and by 2 LVEF categories in 12%. The 3 clinicians agreed on estimated LVEF in only 32% of the patients. RVEF was correctly estimated in 67% of the examinations, but none of the clinicians identified >43% of the relatively few patients with reduced radionuclide RVEF and they greatly disagreed as to who among the patients had a reduced RVEF. Previous myocardial infarction, electrocardiographic infarct location, Killip class, physical signs of left- and right-sided heart failure, radiographic pulmonary congestion and cardiomegaly were analyzed to determine which were the most helpful in predicting LVEF and RVEF. The results disclosed that several variables, traditionally believed to be reliable indexes of reduced ventricular function, were surprisingly poor predictors of LVEF and RVEF.

    OriginalsprogEngelsk
    Sider (fra-til)1301-1307
    Antal sider7
    TidsskriftThe American Journal of Cardiology
    Vol/bind63
    Udgave nummer18
    DOI
    StatusUdgivet - 1 jun. 1989

    Fingeraftryk

    Udforsk hvilke forskningsemner 'Interobserver agreement and accuracy of bedside estimation of right and left ventricular ejection fraction in acute myocardial infarction' indeholder.

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