View point. The dilemma of ejection fraction measurement: A view point of the international college of cardiology

Ejection fraction is often measured by a simple, painless test called an echocardiogram. In patients with coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF), there may be substantial variation between modalities in LVEF determination by core laboratories. Clinical decisions are frequently based on measurement of LVEF, but only limited information exists regarding inconsistencies in LVEF measurements when determined by various imaging modalities and the potential impact of such variability. In a clinical study, the inter-modality variability of LVEF measured by echocardiography, gated single-photon emission-computed tomography (SPECT), and cardiovascular magnetic resonance (CMR) were obtained in patients with left ventricular dysfunction. In a landmark international study, LVEF imaging was performed at 127 clinical sites using up to three widely used imaging modalities. LVEF was independently measured by core laboratories according to standard protocols and the variability in LVEF measurement exceeded 5% in about half of the patients. In treatment decisions, prognosis and research in heart failure, measurement of LVEF would continue to be important.