Access Keys:
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Purpose

Record the patient's cardiac ejection fraction.

Cardiac eCRF:

Field Descriptions and Instructions

Field Name

Description / Instructions

Format

Visit Date(m)

Enter the start date of the first course in this field.

DD-MMM-YYYY

Course #(d)

Indicates the course number the cardiac ejection fraction results are related to based on their date and time.

5 digits

Day in Course(d)

Indicates the day since the beginning of course the cardiac ejection fraction results are related to based on their date and time.

5 digits

Evaluation Date(m)

Enter the date the procedure was performed.

DD-MMM-YYYY

Evaluation Time(m)

Enter the time the procedure was performed.

HH(24):MM

Procedure(m)

Select on of the following procedures from the pick list:
• MUGA
• MRI
• Echocardiogram
• Cardiac Catheterization.
• Nuclear stress test.

Use pick list.

Pre-Ejection Period

Enter the Pre-Ejection Period.

8 digits and 3 decimals

LV Ejection Time

Enter the Left Ventricular Ejection Time.

4 digits

LV Ejection Fraction (%)(m)

Enter the Left Ventricular Fraction percentage.

3 digits

Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.

Validations

Code

Description

Resolutions

CAR01

Evaluation Date is in the future.

Enter a date that is equal to or prior to the current date

CAR02

Check for duplicate Cardiac evaluation entries – Same Date, Time and Procedure.

Correct the Evaluation Date, Time and Procedure.

Derivations

Code

Field Name

Description

CAR1001

Course #

Course number is derived based on the course initiation start dates and the Evaluation Date.

CAR1002

Day in Course

Number of days since the beginning of the course is derived from the course initiation start date and the Evaluation Date.