Background: Left ventricular ejection fraction (LVEF) has prognostic value and is used to guide medical treatment and device implantation. The preferred technique is two-dimensional echo (2DE), although three-dimensional echo (3DE) is more accurate when compared to cardiac magnetic resonance imaging. Our study evaluates the agreement between 2D and 3D LVEF and the potential clinical impact of disagreements. Methods: Participants ≥50 years were included from the Copenhagen City Heart Study. Means of difference (MD) between 2D and 3D volumes and LVEF were assessed, Cox regression models were used to estimate the association between 2D and 3D LVEF <40% and outcome. 3DE were used as reference. Results: In all 1606 participants were included. Median age was 65.4 (IQR: 57.89‒73.6) and 702 (43.7%) were males. Median follow-up was 5.5 (IQR: 4.72‒6.3) in which 102 (6.4%) died and 142 (8.8%) experienced a major adverse cardiovascular event (MACE) and 194 (12.1%) any cardiovascular event. The MD between 2D and 3D LVEF as the LV deteriorated the LV got (LVEF <40%, MD: -14.4 (-15.9 ‒ -13.0) vs. LVEF 40-49% -9.2 (-9.8 ‒ -8.7) vs. LVEF >50%, MD: -0.96 (-1.4 ‒ -0.51)). 3D LVEF <40% was significantly associated with all outcomes (2.85 (95% CI: 1.64‒4.95), (all-cause mortality), 2.71 (95% CI: 1.68‒4.36), (MACE) and 2.41 (95% CI: 1.68‒4.36) (any cardiovascular event). 2D LVEF <40% was only associated to MACE 2.69 (95% CI: 1.25‒5.77). 2DE misclassified (defined as ≥10 percentage units of difference between 2D and 3d LVEF) LVEFs in 508 (31.6%) of all exams. Conclusion: In this population study in low-risk subjects, only 3D LVEF was associated with excess mortality, whereas 2D LVEF was not.

Abstract Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia following coronary artery bypass grafting (CABG). We hypothesized that measures of left atrial (LA) function would be useful in predicting AF in patients undergoing CABG. Methods and Results In the study, 611 patients were included after CABG. All patients had echocardiograms performed preoperatively and LA functional measurements were assessed. These measurements were LA maximum volume index (LAVmax), LA minimum volume index (LAVmin) and LA emptying fraction (LAEF). The endpoint was AF occurring >14 days after surgery. During the follow-up period of a median of 3.7 years, 52 (9%) developed AF. The mean age was 67 years, 84% were male and the average left ventricle ejection fraction was 50 %. No differences were observed between the patients developing AF and those who did not develop AF. No functional LA measurements were significant predictors of AF in the whole CABG population. However, in patients with normal-sized LA (n=532, events: 49), both LAEF and LAVmin were univariable predictors of AF. When the functional measurements were adjusted for the CHADS 2 score, both LAVmin (HR=1.07 (1.01-1.13), p=0.014 ) and LAEF (HR: 1.02 (1.00-1.03, p= 0.023)), remained significant predictors. Conclusion No echocardiographic measurements were significant predictors of AF after CABG. In patients with a normal LA size, LAVmin as well as LAEF were significant predictors of AF. Keywords: atrial fibrillation; cardiac surgery; left atrium; echocardiography

Aims To evaluate the feasibility, time consumption, intra- and inter-observer re-test reproducibility of echocardiographic indexes and classification algorithms of diastolic function. Methods A total of 356 patients were examined prior to coronary artery by-pass grafting and/or aortic valve replacement surgery. A subgroup of 50 were examined with 3 successive echocardiograms in conditions reflecting daily clinical practice. Diastolic parameters suggested by former (2009) and current (2016) guidelines were obtained and analysed. Acquisition and analysis time, plus intra- and inter-observer variability were assessed. Results Most of the parameters’ feasibility were between 93 and 99%, except the TR Vmax (65%). Mean acquisition and analysis time were highest for the left atrial volume (141±24 seconds), in contrast to other parameters which were obtained in approximately one minute. 368 and 360 seconds was in average needed to classify according to the 2009 and 2016 algorithms, respectively (NS). The overall reproducibility was moderate (CV between 10-35%), with TR Vmax having lowest (CV 9.9-12%) and E/e’ the highest (CV 22-35%) variation. The 2009 algorithm resulted in higher indeterminate cases vs. the 2016 algorithm. Comparing the old and recent guidelines, 20 and 8 patients were reclassified during inter-examiner analysis, respectively. Conclusion The diastolic parameters are, in general, feasible and time efficient. Reproducibility is moderate. The 2016 guidelines algorithm seemed superior to the 2009 algorithm in terms of its feasibility and precision to classify patients in a uniform matter. Time consumption was equal. The 2016 algorithm proved more restrictive than 2009 in classifying patients with advanced stages of DD.