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Background <p>Left ventricular ejection fraction (LVEF) remains central to heart failure phenotyping and device-based decision-making, yet the degree to which apical four-chamber (A4C) and biplane Simpson measurements diverge at clinically actionable thresholds is not well defined.</p> Methods <p>We analysed 1,022 unique algorithmically derived echocardiographic studies from 784 patients in the credentialed MIMIC-IV-ECHO-Ext-LVVOLUMES-A4C-ROI resource. Each study contained paired A4C and biplane volumetric labels derived from the same annotated DICOM sequence. Discordance was defined primarily at the HFrEF threshold (LVEF &lt; 40%). Agreement was assessed with Bland–Altman analysis, and independent predictors were evaluated using multivariable logistic regression with cluster-robust standard errors.</p> Results <p>LVEF discordance at the HFrEF threshold occurred in 48 of 1,022 studies (4.7%, 95% CI 3.5–6.2%). At the ICD threshold (LVEF &lt; 35%), discordance was present in 32 studies (3.1%). In the prespecified borderline zone (A4C LVEF 35–45%; <i>n</i> = 81), discordance rose to 30.9% (95% CI 21.9–41.6%). Mean bias was 0.11%, but the 95% limits of agreement were wide (− 13.5% to + 13.7%). LV end-diastolic volume was the only independent predictor of discordance (OR 1.61 per SD, 95% CI 1.27–2.05; <i>p</i> = 0.0001), and this association persisted after adjustment for acquisition variables.</p> Conclusions <p>Discordance between A4C and biplane Simpson LVEF is uncommon across an unselected cohort but becomes frequent near therapeutic cut-offs. LV dilatation is the dominant driver. These findings support continued preference for biplane quantification when the ventricle is enlarged or the measured LVEF falls near a treatment threshold.</p>

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Methodological discordance between apical four-chamber and biplane Simpson’s method for left ventricular ejection fraction: a retrospective study of a credentialed echocardiographic dataset

  • 期刊论文

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  • 发表日期：

    2026年5月9日

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  • Hasan Burak İşleyen,
  • Sevil Tugrul Yavuz,
  • Sercan Bulut,
  • Fatih Kizkapan,
  • Cevahir Alioglu,
  • Necla Zeynep Eren,
  • Ali Arda Sozen,
  • Mahsa Khanmohammadi

摘要

Background

Left ventricular ejection fraction (LVEF) remains central to heart failure phenotyping and device-based decision-making, yet the degree to which apical four-chamber (A4C) and biplane Simpson measurements diverge at clinically actionable thresholds is not well defined.

Methods

We analysed 1,022 unique algorithmically derived echocardiographic studies from 784 patients in the credentialed MIMIC-IV-ECHO-Ext-LVVOLUMES-A4C-ROI resource. Each study contained paired A4C and biplane volumetric labels derived from the same annotated DICOM sequence. Discordance was defined primarily at the HFrEF threshold (LVEF < 40%). Agreement was assessed with Bland–Altman analysis, and independent predictors were evaluated using multivariable logistic regression with cluster-robust standard errors.

Results

LVEF discordance at the HFrEF threshold occurred in 48 of 1,022 studies (4.7%, 95% CI 3.5–6.2%). At the ICD threshold (LVEF < 35%), discordance was present in 32 studies (3.1%). In the prespecified borderline zone (A4C LVEF 35–45%; n = 81), discordance rose to 30.9% (95% CI 21.9–41.6%). Mean bias was 0.11%, but the 95% limits of agreement were wide (− 13.5% to + 13.7%). LV end-diastolic volume was the only independent predictor of discordance (OR 1.61 per SD, 95% CI 1.27–2.05; p = 0.0001), and this association persisted after adjustment for acquisition variables.

Conclusions

Discordance between A4C and biplane Simpson LVEF is uncommon across an unselected cohort but becomes frequent near therapeutic cut-offs. LV dilatation is the dominant driver. These findings support continued preference for biplane quantification when the ventricle is enlarged or the measured LVEF falls near a treatment threshold.