Validation of Estimating Left Ventricular Ejection Fraction by Mitral
Annular Displacement Derived From Speckle-Tracking Echocardiography: A
Neglected Method for Evaluating Left Ventricular Systolic Function
Abstract
Background The accurate measurement of left ventricular (LV) ejection
fraction (EF) is highly dependent on professional experience and
adequate visualization. The tissue motion of mitral annular displacement
(TMAD) can be easily and quickly assessed using speckle tracking
echocardiography (STE) for evaluating the LV systolic function, even in
patients with poor acoustic windows. Therefore, this study aimed to
validate whether LVEF can be estimated using the STE-derived TMAD when
LVEF is not available. Methods Four-hundred fifty-six outpatients were
consecutively enrolled in this study. An optimized regression model for
LVEF-TMAD was developed in the derivation set (n=287), and its
reliability was verified in the validation set (n=123) and regional wall
motion abnormalities (RWMA) set (n=46). Results In the derivation set,
the power models had the highest F-value, and the power equations were
chosen to estimate LVEF according to TMAD in the validation set.
Near-zero bias and a narrow range of differences were observed between
the observed and estimated LVEF. The highest intra-class correlation
coefficient was observed between the observed LVEF and estimated LVEF
according to the normalized TMAD at the midpoint of mitral annular
(nTMADmid). Moreover, there were no significant differences between the
observed and estimated LVEF in the RWMA set. Conclusion The LVEF can be
estimated with the STE-derived TMAD using a power equation, even for
patients with RWMA, and the nTMADmid may be the optimal parameter. The
proposed method may provide a clinically acceptable alternative for
evaluating LV systolic function when the direct measurement of LVEF is
not available.