Sex differences in the agreement between left ventricular ejection fraction measured by myocardial perfusion scintigraphy and by echocardiography

Sams Jaker, Amjad Burgan, Vineet Prakash, Alexander Birkinshaw, Kishan Moosai, Adam Jacques, David Fluck, Mark MacGregor, Otar Lazariashvili, Pankaj Sharma, Chris H Fry, Thang S Han*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background: Left ventricular ejection fraction (LVEF) is generally measured by echocardiography (Echo) but is increasingly available with myocardial perfusion scintigraphy (MPS). With MPS the threshold of LVEF below which there is a risk for myocardial infarct or sudden cardiac death is higher for women (51%) than for men (43%). We tested the hypothesis that such a sex difference may also occur with Echo and MPS. Methods: 404 men, mean age=67.7±SD=12.3yr; 339 women, 67.7±11.7yr had separate MPS and Echo examinations within 6months. A subset of 327 of these patients (181 men, 68.8±12.1yr; 146 women, 66.4±12.1yr) had examinations within 1month and were additionally analysed as this sub-group. MPS and Echo were used to measure LVEF at rest and their agreement (neither considered as a reference method) was assessed by Bland-Altman plots: LVEF difference (MPS minus Echo) against average LVEF (푀푀푀푀푀푀+퐸퐸퐸퐸ℎ표표2). Results: Of patients who had MPS and Echo performed within 6months, mean LVEF difference=+1.1% (95% limits of agreement: -19.3 to +21.6) in men but +10.9% (-10.7 to +32.5) in women. LVEF difference diverged from zero marginally in men (mean difference=+1.1, 95%CI =+0.1 to +2.1, p=0.028) but more in women (+10.9, +9.8 to +12.1, p<0.001). The LVEF difference correlated with average LVEF itself in both men (r=0.305, p<0.001) and women (r=0.361, p<0.001), and with age in women (r=0.117, p=0.031). Similar results were observed for the subset. Conclusions: Caution should be taken when interpreting LVEF measured by different techniques due to their wide limits of agreement and systematic bias, more markedly in women.
Original languageEnglish
Number of pages9
JournalJRSM Cardiovascular Disease
Volume9
Early online date24 Mar 2020
DOIs
Publication statusE-pub ahead of print - 24 Mar 2020

Keywords

  • Methods;
  • bias;
  • cardiology;
  • nuclear medicine

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