Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging

J Am Coll Cardiol. 2004 Sep 1;44(5):1030-5. doi: 10.1016/j.jacc.2004.05.068.


Objectives: We evaluated the accuracy and reproducibility of contrast echocardiography versus tissue harmonic imaging for measurements of left ventricular (LV) volumes and ejection fraction (EF) compared to magnetic resonance imaging (MRI).

Methods: Digital echo recordings of apical LV views before and after intravenous contrast were collected from 110 consecutive patients. Magnetic resonance imaging of multiple short-axis LV sections was performed with a 1.5-T scanner. Left ventricular volumes and EF were calculated offline by method of discs. Thirty randomly selected patients were reanalyzed for intraobserver and interobserver variability.

Results: Compared with baseline, contrast echo increased feasibility for single-plane and biplane volume analysis from 87% to 100% and from 79% to 95%, respectively. The Bland-Altman analysis demonstrated volume underestimation by echo, but much less pronounced with contrast. Limits of agreement between echo and MRI narrowed significantly with contrast: from -18.1% to 8.3% to -7.7% to 4.1% (EF), from -98.2 to -11.7 ml to -59.0 to 10.7 ml (end-diastolic volume), and from -58.8 to 21.8 ml to -38.6 to 23.9 ml (end-systolic volume). Ejection fraction from precontrast echo and MRI differed by > or =10% (EF units) in 23 patients versus 0 after contrast (p < 0.001). At intraobserver and interobserver analysis, limits of agreement for EF narrowed significantly with contrast.

Conclusions: The two-dimensional echocardiographic evaluation of LV volumes and EF in non-selected cardiac patients was found to be more accurate and reproducible when adding an intravenous contrast agent.

Publication types

  • Comparative Study
  • Lecture
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Echocardiography / methods*
  • Female
  • Fluorocarbons
  • Humans
  • Image Enhancement
  • Magnetic Resonance Imaging
  • Male
  • Microspheres
  • Middle Aged
  • Phospholipids
  • Reproducibility of Results
  • Stroke Volume*
  • Sulfur Hexafluoride
  • Ventricular Function, Left*


  • Fluorocarbons
  • Phospholipids
  • contrast agent BR1
  • Sulfur Hexafluoride
  • perflutren