TY - JOUR
T1 - Challenges With Left Ventricular Functional Parameters
T2 - The Pediatric Heart Network Normal Echocardiogram Database
AU - Pediatric Heart Network Investigators
AU - Frommelt, Peter C.
AU - Minich, L. Lu Ann
AU - Trachtenberg, Felicia L.
AU - Altmann, Karen
AU - Camarda, Joseph
AU - Cohen, Meryl S.
AU - Colan, Steven D.
AU - Dragulescu, Andreea
AU - Frommelt, Michele A.
AU - Johnson, Tiffanie R.
AU - Kovalchin, John P.
AU - Lin, Lina
AU - Mahgerefteh, Joseph
AU - Nutting, Arni
AU - Parra, David A.
AU - Pearson, Gail D.
AU - Pignatelli, Ricardo
AU - Sachdeva, Ritu
AU - Soriano, Brian D.
AU - Spurney, Christopher
AU - Srivastava, Shubhika
AU - Statile, Christopher J.
AU - Stelter, Jessica
AU - Stylianou, Mario
AU - Thankavel, Poonam P.
AU - Tierney, E. Seda
AU - van der Velde, Mary E.
AU - Lopez, Leo
AU - Burns, Kristin
AU - Kaltman, Jonathan
AU - Pearson, Gail
AU - Pemberton, Victoria
AU - Mahony, Lynn
AU - Chen, Shan
AU - Colan, Steven
AU - Gallagher, Dianne
AU - Gerstenberger, Eric
AU - Gongwer, Russell
AU - Granger, Suzanne
AU - Keosaian, Julia
AU - Langley, Susanne
AU - Mansolf, Tammi
AU - Moine, Stephanie
AU - Morrison, Andrew
AU - Nelson, Katelyn
AU - Ni, Brenda
AU - Ortiz, Janet
AU - Pober, David
AU - Pucillo, Michelle
AU - Stark, Paul
N1 - Publisher Copyright:
© 2019 American Society of Echocardiography
PY - 2019/10
Y1 - 2019/10
N2 - 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.
AB - 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.
KW - Echocardiography
KW - Ejection fraction
KW - Left ventricle
KW - Pediatric
KW - Shortening fraction
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UR - http://www.scopus.com/inward/citedby.url?scp=85069698907&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2019.05.025
DO - 10.1016/j.echo.2019.05.025
M3 - Article
C2 - 31351792
AN - SCOPUS:85069698907
SN - 0894-7317
VL - 32
SP - 1331-1338.e1
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 10
ER -