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Echocardiography. 2019 Jun 27. doi: 10.1111/echo.14409. [Epub ahead of print]

Accuracy and reliability of qualitative echocardiography assessment of right ventricular size and function in neonates.

Author information

1
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
2
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
3
Department of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada.
4
Hospital Infantil de Mexico Federico Gomez, Mexico, Mexico.
5
Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.
6
Texas Children's Hospital, Houston, Texas, USA.
7
Royal College of Surgeons in Ireland, Dublin, Ireland.

Abstract

BACKGROUND:

Subjective assessment of right ventricular (RV) function by neonatal echocardiography lacks validation. Incorrect diagnostic assignment in patients with suspected pulmonary hypertension (PH) may lead to unnecessary treatment or missed treatment opportunities.

METHODS:

Six evaluators (experts [n = 3], novice [n = 3]) were asked to independently rate RV characteristics (global function, dilation, and septal flattening) based on standardized echocardiography images. We randomly selected 60 infants, ≥35 weeks gestation at birth, of whom 30 were clinically unwell with acute pulmonary hypertension (aPH) and 30 were healthy controls. aPH was defined by echocardiography presence of right-left shunting across transitional shunts or elevated right ventricular systolic pressure as estimated by the magnitude of the regurgitant jet across the tricuspid valve with impaired oxygenation. Inter-rater comparative evaluation within groups and between groups was performed using Kappa statistics.

RESULTS:

Global agreement between evaluators for subjective assessment of RV function (0.3 [0.03], P < 0.001), size (0.14 [0.02], P < 0.001), and septal flattening (0.2 [0.02], P < 0.001) was uniformly poor. Agreement in RV function assessment was marginally better for both expert (0.32 [0.08], P < 0.001 vs 0.13 [0.081], and P < 0.001) and novice (0.4 [0.08], P < 0.001 vs 0.06 [0.07], and P < 0.001) evaluators. Overall, the diagnosis of aPH vs control was misclassified in 18% of cases.

CONCLUSION:

This study demonstrated significant variability in qualitative assessment of RV size and function by trained evaluators, regardless of level of expertise attained. The reliability of objective measures of RV hemodynamics requires prospective evaluation.

KEYWORDS:

echocardiography; pulmonary hypertension; reliability testing; right ventricular function

PMID:
31246348
DOI:
10.1111/echo.14409

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