Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy

J Am Coll Cardiol. 2013 Jan 8;61(1):77-84. doi: 10.1016/j.jacc.2012.09.035. Epub 2012 Nov 28.


Objectives: The aim of this study was to identify the best echocardiographic method for sequential quantification of left ventricular (LV) ejection fraction (EF) and volumes in patients undergoing cancer chemotherapy.

Background: Decisions regarding cancer therapy are based on temporal changes of EF. However the method for EF measurement with the lowest temporal variability is unknown.

Methods: We selected patients in whom stable function in the face of chemotherapy for breast cancer was defined by stability of global longitudinal strain (GLS) at up to 5 time points (baseline, 3, 6, 9, and 12 months). In this way, changes in EF were considered to reflect temporal variability of measurements rather than cardiotoxicity. A comprehensive echocardiogram consisting of 2-dimensional (2D) and 3-dimensional (3D) acquisitions with and without contrast administration was performed at each time point. Stable LV function was defined as normal GLS (≤-16.0%) at each examination. The EF and volumes were measured with 2D-biplane Simpson's method, 2D-triplane, and 3-dimensional echocardiography (3DE) by 2 investigators blinded to any clinical data. Inter-, intra-, and test-retest variability were assessed in a subgroup. Variability was assessed by analysis of variance and compared with Levene's or t test.

Results: Among 56 patients (all female, 54 ± 13 years of age), noncontrast 3D EF, end-diastolic volume, and end-systolic volume had significantly lower temporal variability than all other methods. Contrast only decreased the temporal variability of LV end-diastolic volume measurements by the 2D biplane method. Our data suggest that a temporal variability in EF of 0.06 might occur with noncontrast 3DE due to physiological differences and measurement variability, whereas this might be >0.10 with 2D methods. Overall, 3DE also had the best intra- and inter-observer as well as test-retest variability.

Conclusions: Noncontrast 3DE was the most reproducible technique for LVEF and LV volume measurements over 1 year of follow-up.

MeSH terms

  • Analysis of Variance
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Breast Neoplasms / drug therapy
  • Contrast Media / administration & dosage
  • Cyclophosphamide / therapeutic use
  • Diastole / physiology
  • Docetaxel
  • Doxorubicin / therapeutic use
  • Echocardiography*
  • Echocardiography, Three-Dimensional*
  • Female
  • Heart Ventricles / diagnostic imaging
  • Humans
  • Middle Aged
  • Paclitaxel / therapeutic use
  • Prospective Studies
  • Reproducibility of Results
  • Stroke Volume / physiology*
  • Systole / physiology
  • Taxoids / therapeutic use
  • Trastuzumab
  • Ventricular Function, Left / physiology*


  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • Contrast Media
  • Taxoids
  • Docetaxel
  • Doxorubicin
  • Cyclophosphamide
  • Trastuzumab
  • Paclitaxel