Multimodal assessment of the left ventricular ejection fraction by echocardiography, cardiac computed tomography and cardiac magnetic resonance in patients after SARS-CoV2 infection

Paweł Gać^1*Andrzej Wysocki²Ewelina Beck¹Małgorzata Poręba³Rafał Poręba³

• ¹Wroclaw Medical University, Wrocław, Poland
• ²4th Military Hospital, Wroclaw, Poland
• ³Wroclaw University of Health and Sport Sciences, Wroclaw, Poland

Objective. The aim of the study was to compare the assessment of left ventricular ejection fraction (LVEF) performed using echocardiography, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) in patients after SARS-CoV2 infection. Material and methods. The study group consisted of 108 patients with a history of SARS-CoV-2 infection. Echocardiography, CCT and CMR examinations were performed. In echocardiography, LVEF (LVEFECHO) was determined from the apical 4-chamber and 2-chamber views, with the biplane Simpson's method. In CCT, LVEF was assessed based on the contours of the left ventricular endocardium and epicardium in multiplanar reconstructions (MPR) from the multiphase of the entire cardiac cycle, which was part of the coronary computed tomography angiography performed with retrospective ECG gating with radiation dose modulation (LVEFCCT1). Additionally, in CCT, LVEF was assessed based on the left ventricular blood pool in the above reconstructions (LVEFCCT2). In CMR (LVEFCMR), a standard volumetric method was used using CINE sequence images in the 2-chamber projection in the long axis and in the short axis of the left ventricle. The coefficient of variation of measurements (CV) was calculated for each pair of LVEF measurements, as well as for all LVEF measurements. Results. LVEFECHO was statistically significantly lower than LVEFCCT1 and LVEFCCT2. LVEFCMR was statistically significantly lower than LVEFCCT1 and LVEFCCT2. CV for all LVEF measurements was 4.61±1.73%. When comparing pairs of LVEF measurements, the lowest CV was observed for LVEFCCT1 and LVEFCCT2 (2.97±2.64%), while the highest CV was observed for LVEFECHO and LVEFCCT2 (6.04±3.39%). A positive correlation was found between BMI and CV of LVEF measurements (r=0.44, p<0.05), and between heart rate and CV of LVEF measurements (r=0.37, p<0.05). A negative correlation existed between LVEF measured by ECHO and CV of LVEF measurements (r=-0.27, p<0.05). Conclusions. There are statistically significant differences in LVEF measurements in patients with a history of SARS-CoV-2 infection using different cardiac imaging modalities. Cardiac computed tomography overestimates LVEF compared to echocardiography and cardiac magnetic resonance imaging. Patients with abnormal body mass, suboptimal heart rate and reduced left ventricular systolic function are subgroups with increased variability of LVEF measurements in different cardiac imaging modalities.