Which method is used to quantify left ventricular ejection fraction most accurately from transthoracic views?

Which method is used to quantify left ventricular ejection fraction most accurately from transthoracic views?

• A. Teichholz method
• B. Ellipsoid method
• C. 3D volumetric method
• D. Simpson’s biplane method

Answer: (D)

Accurately quantifying LV ejection fraction from transthoracic images hinges on estimating true ventricular volumes rather than relying on a single dimension or a fixed shape. Simpson’s biplane method does this by tracing the endocardial border in two orthogonal apical views (typically 4-chamber and 2-chamber) and calculating volumes with the method of discs. By summing the volumes of many discs, it yields end-diastolic and end-systolic volumes, and EF is then EDV minus ESV divided by EDV. This approach better represents the actual LV shape and accommodates regional wall-motion abnormalities, reducing geometric bias and improving accuracy compared with methods that assume a specific geometry from a single view. The Teichholz method relies on a single dimension from one view and assumes a particular LV shape, which can be inaccurate in remodeled or irregular ventricles. The ellipsoid model imposes a fixed ellipsoidal form, also leading to errors when the ventricle deviates from that geometry. When high-quality 3D data are available, 3D volumetric assessment can be very accurate since it constructs volumes directly from the dataset without geometric assumptions, but in standard transthoracic practice, Simpson’s biplane method remains the most reliable among commonly used 2D approaches.

Accurately quantifying LV ejection fraction from transthoracic images hinges on estimating true ventricular volumes rather than relying on a single dimension or a fixed shape. Simpson’s biplane method does this by tracing the endocardial border in two orthogonal apical views (typically 4-chamber and 2-chamber) and calculating volumes with the method of discs. By summing the volumes of many discs, it yields end-diastolic and end-systolic volumes, and EF is then EDV minus ESV divided by EDV. This approach better represents the actual LV shape and accommodates regional wall-motion abnormalities, reducing geometric bias and improving accuracy compared with methods that assume a specific geometry from a single view.

The Teichholz method relies on a single dimension from one view and assumes a particular LV shape, which can be inaccurate in remodeled or irregular ventricles. The ellipsoid model imposes a fixed ellipsoidal form, also leading to errors when the ventricle deviates from that geometry. When high-quality 3D data are available, 3D volumetric assessment can be very accurate since it constructs volumes directly from the dataset without geometric assumptions, but in standard transthoracic practice, Simpson’s biplane method remains the most reliable among commonly used 2D approaches.