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J Am Soc Echocardiogr. 2019 Oct;32(10):1331-1338.e1. doi: 10.1016/j.echo.2019.05.025. Epub 2019 Jul 24.

Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database.

Author information

1
Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: pfrommelt@chw.org.
2
University of Utah, Salt Lake City, Utah.
3
New England Research Institute, Boston, Massachusetts.
4
Columbia University Medical Center, New York, New York.
5
Northwestern University, Chicago, Illinois.
6
Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania.
7
Boston Children's Hospital, Boston, Massachusetts.
8
Hospital for Sick Children, Toronto, Ontario, Canada.
9
Medical College of Wisconsin, Milwaukee, Wisconsin.
10
Indiana University, Indianapolis, Indiana.
11
Nationwide Children's Hospital, Columbus, Ohio.
12
The Children's Hospital at Montefiore, New York, New York.
13
Medical University of South Carolina, Charleston, South Carolina.
14
Vanderbilt Medical Center (D.A.P.), Nashville, Tennessee.
15
National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
16
Baylor College of Medicine, Houston, Texas.
17
Emory University School of Medicine, Atlanta, Georgia.
18
Seattle Children's Hospital, Seattle, Washington.
19
Children's National Heart Institute, Washington, DC.
20
Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
21
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
22
UT Southwestern Medical Center, Dallas, Texas.
23
Stanford University, Palo Alto, California.
24
University of Michigan, Ann Arbor, Michigan.

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.

KEYWORDS:

Echocardiography; Ejection fraction; Left ventricle; Pediatric; Shortening fraction

PMID:
31351792
PMCID:
PMC6779514
[Available on 2020-10-01]
DOI:
10.1016/j.echo.2019.05.025

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