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Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database. J Am Soc Echocardiogr 2019 Oct;32(10):1331-1338.e1

Date

07/29/2019

Pubmed ID

31351792

Pubmed Central ID

PMC6779514

DOI

10.1016/j.echo.2019.05.025

Scopus ID

2-s2.0-85069698907

Abstract

BACKGROUND: The reliability of left ventricular (LV) systolic functional indices calculated from blinded echocardiographic measurements of LV size has not been tested in a large cohort of healthy children. The objective of this study was to estimate interobserver variability in standard measurements of LV size and systolic function in children with normal cardiac anatomy and qualitatively normal function.

METHODS: The Pediatric Heart Network Normal Echocardiogram Database collected normal echocardiograms from healthy children ≤18 years old distributed equally by age, gender, and race. A core lab used two-dimensional echocardiograms to measure LV dimensions from which a separate data coordinating center calculated LV volumes and systolic functional indices. To evaluate interobserver variability, two independent expert pediatric echocardiographic observers remeasured LV dimensions on a subset of studies, while blinded to calculated volumes and functional indices.

RESULTS: Of 3,215 subjects with measurable images, 552 (17%) had a calculated LV shortening fraction (SF) < 25% and/or LV ejection fraction (EF) < 50%; the subjects were significantly younger and smaller than those with normal values. When the core lab and independent observer measurements were compared, individual LV size parameter intraclass correlation coefficients were high (0.81-0.99), indicating high reproducibility. The intraclass correlation coefficients were lower for SF (0.24) and EF (0.56). Comparing reviewers, 40/56 (71%) of those with an abnormal SF and 36/104 (35%) of those with a normal SF based on core lab measurements were calculated as abnormal from at least one independent observer. In contrast, an abnormal EF was less commonly calculated from the independent observers' repeat measures; only 9/47 (19%) of those with an abnormal EF and 8/113 (7%) of those with a normal EF based on core lab measurements were calculated as abnormal by at least one independent observer.

CONCLUSIONS: Although blinded measurements of LV size show good reproducibility in healthy children, subsequently calculated LV functional indices reveal significant variability despite qualitatively normal systolic function. This suggests that, in clinical practice, abnormal SF/EF values may result in repeat measures of LV size to match the subjective assessment of function. Abnormal LV functional indices were more prevalent in younger, smaller children.

Author List

Frommelt PC, Minich LL, Trachtenberg FL, Altmann K, Camarda J, Cohen MS, Colan SD, Dragulescu A, Frommelt MA, Johnson TR, Kovalchin JP, Lin L, Mahgerefteh J, Nutting A, Parra DA, Pearson GD, Pignatelli R, Sachdeva R, Soriano BD, Spurney C, Srivastava S, Statile CJ, Stelter J, Stylianou M, Thankavel PP, Tierney ES, van der Velde ME, Lopez L, Pediatric Heart Network Investigators

Authors

Peter C. Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin
Michele Ann Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin




jenkins-FCD Prod-399 190a069c593fb5498b7fcd942f44b7bc9cdc7ea1