Age-related discrepancies between M-mode and volumetric left ventricular ejection fraction measurements: a cross-sectional echocardiographic analysis

Abstract Background Accurate assessment of left ventricular ejection fraction (LVEF) is critical in cardiovascular care. While M-mode echocardiography remains widely utilized due to its simplicity and accessibility, its reliance on geometric assumptions may compromise accuracy—particularly in older adults. In contrast, volumetric (biplane Simpson’s) methods offer more anatomically faithful measurements but are less frequently employed in routine practice. The degree to which LVEF measurements diverge between these modalities across different age groups remains inadequately quantified. To investigate age-related discrepancies in LVEF measurements between M-mode and biplane Simpson’s methods and evaluate the potential impact of aging on the reliability of M-mode–based assessments. Methods We retrospectively analyzed 10,867 transthoracic echocardiograms from adults aged ≥18 years. LVEF was calculated using both M-mode and biplane Simpson’s method. Only patients with LVEF ≥50% and no regional wall motion abnormalities were included in the analysis. Discrepancy was defined as the absolute difference between modalities, with thresholds set at ≥5% and ≥10%. Patients were stratified into four age groups: