Estimation of Ejection Fraction with Ventriculography Versus Echocardiography in Patients Referred for Cardiac Surgery

Oct 12, 2026

Uploaded by hdkawk

The study compares ejection fraction (EF) estimation by ventriculography (VG) and echocardiography (ECHO) in patients referred for cardiac surgery, validating findings against previously published data. One hundred surgical candidates underwent VG and subsequent trans-thoracic ECHO, with EF measured from ventriculograms and quantified on ECHO using the biplane Simpson method. VG produced significantly higher EF than ECHO overall, with overestimation most pronounced above 50% EF. When VG EF was below 50%, ECHO results were more consistent.

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Estimation of Ejection Fraction with Ventriculography Versus Echocardiography in Patients Referred for Cardiac Surgery Alexander Manché 1,* , Elton Pllaha2 and Liberato Camilleri3 1Department of Cardiothoracic Surgery, Mater Dei Hospital, Malta 2Department of Cardiology, Mater Dei Hospital, Malta 3Department of Statistics and Operations Research, Faculty of Science, University of Malta, Malta Abstract: Aim: The aim of this study was to compare the estimation of ejection fraction (EF) by ventricuography (VG) and echocardiography (ECHO) in patients referred for surgery and to validate the results by comparison with other published data. Methods: One hundred patients who underwent VG prior to surgery were subjected to a trans-thoracic ECHO. Radiographers calculated the EF by tracing the outer border of the ventriculogram during systole and diastole. A single cardiologist, who was blinded to the angiogram result, measured EF during trans-thoracic ECHO using the biplane Simpson’s method. Results: EF was significantly higher by VG versus ECHO for the whole group (67 . 9±13 .2 vs 55. 7±8 .5, p=0 .000) . In 81 patients the EF estimated at VG was higher than that calculated at ECHO (71 .7±10 .2 vs 55. 9±7 .2, p=0 .000) . In 19 patients the EF estimated at VG was lower than that calculated at ECHO, but the difference was not significant (51 . 8±12 .9 by VG vs 55.4±12 . 8, p=0 .387) . In 13 patients, with an EF less than 50% on VG, the correlation with ECHO was very good (42 . 0±9 .0 vs 42.0±8 .3, p=0 . 995) . Two patients with an EF fraction under 30% had similar measurements by VG and ECHO. The EF range as measured by ECHO was consistent with published data. Conclusion: Ventriculography overestimates EF when compared with ECHO. When EF is less than 50% on VG, ECHO findings were similar. The value of ventriculography in patients referred for cardiac surgery is now being brought into question when ECHO, a better and less invasive test that measures EF, is available. Keywords: Ejection fraction, ventriculography, echocardiography, cardiac surgery. INTRODUCTION Ejection fraction is readily measured invasively atventriculography and non-invasively by echocardiography. A value of around 65% is considered normal [1] . Ejection fraction contributes to pre-operative risk assessment when using the Parsonnet or EuroSCORE systems. The calculation of EF and assessment of regional wall motion by contrast injection of the left ventricle has been a gold standard for over four decades [2] since its introduction by Seldinger in 1953 [3] . The increasing use of VG sparked concerns over radiation exposure [4] and brought its validity into question, especially when patients had already undergone echocardiographic estimation of ventricular function [5,6] . Surveys have highlighted a wide divergence of its use, with the suggestion that reimbursement by private health schemes may be a driving force [7] . This is not an issue in our local public-funded Health Service. Although our resident surgeons, comfortable *Address corresponding to this author at the Department of Cardiothoracic Surgery, Mater Dei Hospital, Malta; Tel/Fax: +356 25455486; Mob: +356 79320111; E-mail: manchea@maltanet. net E-ISSN: 2311-052X/16 with ventriculography, initially expressed reluctance to embrace echocardiography, the strong drive to change eventually arose both from within our surgical fraternity as well as from cardiologists. Factors included the divergence of EF estimation between that calculated by radiographers and that visually estimated by surgeons, the elevated range of EF calculated locally by ventriculography, far exceeding internationally expected norms [8,9] resulting in an underestimation of operative risk, the increasing appointment of non-invasive cardiologists providing an ECHO service, and the increasing reluctance of invasive cardiologists to perform ventriculography. Against this background we evaluated our changing

FAQs

What was the main purpose of comparing ventriculography and echocardiography in this study?

To compare how ejection fraction (EF) is estimated by ventriculography (VG) and echocardiography (ECHO) in patients referred for cardiac surgery, and to validate results by comparison with other published data.

How was EF measured on ventriculography and on echocardiography?

Radiographers calculated EF on VG by tracing the outer border of the ventriculogram during systole and diastole and using derived systolic and diastolic volumes. A blinded cardiologist measured EF on trans-thoracic ECHO using the biplane Simpson’s method.

What were the study findings about EF differences between VG and ECHO?

EF was significantly higher by VG than by ECHO for the whole group. In many patients VG estimated higher EF than ECHO, while in a smaller number VG was lower but the difference was not significant; for patients with VG EF under 50%, ECHO showed similar values.

Oct 12, 2026

Uploaded by hdkawk