Accuracy of echocardiographic area-length method in chronic myocardial infarction: comparison with cardiac CT in pigs

Background We evaluated echocardiographic area-length methods to measure left ventricle (LV) volumes and ejection fraction (EF) in parasternal short axis views in comparison with cardiac computed tomography (CT) in pigs with chronic myocardial infarction (MI). Methods Male farm pigs with surgical occlusion of the left anterior descending coronary artery ( n = 9) or sham operation ( n = 5) had transthoracic echocardiography and cardiac-CT 3 months after surgery. We measured length of the LV in parasternal long axis view, and both systolic and diastolic LV areas in parasternal short axis views at the level of mitral valve, papillary muscles and apex. Volumes and EF of the LV were calculated using Simpson’s method of discs (tri-plane area) or Cylinder-hemiellipsoid method (single plane area). Results The pigs with coronary occlusion had anterior MI scars and reduced EF (average EF 42 ± 10%) by CT. Measurements of LV volumes and EF were reproducible by echocardiography. Compared with CT, end-diastolic volume (EDV) measured by echocardiography showed good correlation and agreement using either Simpson’s method ( r = 0.90; mean difference −2, 95% CI −47 to 43 mL) or Cylinder-hemiellipsoid method ( r = 0.94; mean difference 3, 95% CI −44 to 49 mL). Furthermore, End-systolic volume (ESV) measured by echocardiography showed also good correlation and agreement using either Simpson’s method ( r = 0.94; mean difference 12 ml, 95% CI: −16 to 40) or Cylinder-hemiellipsoid method ( r = 0.97; mean difference:13 ml, 95% CI: −8 to 33). EF was underestimated using either Simpson’s method ( r = 0.78; mean difference −6, 95% CI −11 to 1%) or Cylinder-hemiellipsoid method ( r = 0.74; mean difference −4, 95% CI–10 to 2%). Conclusion Our results indicate that measurement of LV volumes may be accurate, but EF is underestimated using either three or single parasternal short axis planes by echocardiography in a large animal model of chronic MI.