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Jens-Uwe Voigt, Making a black box transparent, European Heart Journal - Cardiovascular Imaging, Volume 14, Issue 3, March 2013, Pages 201–202, https://doi.org/10.1093/ehjci/jes213
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Guidelines and gut feelings
Ejection fraction (EF) is known to be a valuable parameter in clinical decision-making. This knowledge has been accumulated over decades, while EF has been measured with a lot of different imaging modalities of different qualities. The interpretation of EF is always based on the gut feeling of the experienced clinician about how accurately a certain method can measure it and how reproducible it is a certain method can measure it. Therefore, in the world of clinical cardiology, cut-off values for absolute measurements or relative changes in EF will always be considered with necessary tolerance. We know that in the clinical routine we have to live with a reproducibility for echocardiographic EF measurements in the range of 5–10% and so we are often tempted to trade-off the minor gains in clinical information from guideline conform measurements1 with time savings gained from eyeballing. In the scientific world, however, no research paper would be accepted if EF was not measured at least using the bi-plane Simpson's approach if not even by modern 3D volumetry. However, decades of research showing that these techniques improve the quality of our measurements have not led to a change in our attitude in the clinical echo lab, since the gain in accuracy which can be achieved in a routine setting does not outweigh the additional effort.
