Left ventricular ejection fraction: a triangular comparison between contrast-angiography, radionuclide ventriculography and cine-MR obtained in a routine clinical setting.

Cine-magnetic resonance (MR), radionuclide ventriculography (MUGA) and contrast-enhanced ventriculography (CV) were compared in 120 non-selected patients for the assessment of left ventricular ejection fraction (EF), in order to estimate inter-method discrepancies in a routine clinical setting. The EFs obtained in the 58 patients who underwent all three examinations were not significantly different : CV = 49.9 +/- 17.8, MUGA = 48.5 +/- 17.4, MR = 51.0 +/- 17.1; nor were there any significant differences between paired measurements : CV-MUGA : 1.4 +/- 12.1, CV-MR : -1.1 +/- 11.0, MUGA-MR : -2.5 +/- 10.7. From the whole population (CV-MUGA n = 59, CV-MR n = 94, MUGA-MR n = 83), no significant difference was seen for absolute paired differences CV-MUGA : 8.8 +/- 8.2, CV-MR : 8.2 +/- 6.8, MUGA-MR : 7.8 +/- 6.7 and for observed intraclass correlation coefficients (R : 0.77, 0.81 et 0.85 resp.). Despite good overall agreement indicating that these three methods lead to overall similar results, significant individual discrepancies, in the range of 8 points, were observed in this routine clinical setting. Thus, for the assessment of EF; the degree of concordance (or discrepancy) between CV, MUGA or MR appears very similar, indicating that no particular method should be preferred to another, unless the clinical situation indicates the most appropriate method.