Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database
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...
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| Published in | Journal of the American Society of Echocardiography Vol. 32; no. 10; pp. 1331 - 1338.e1 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.10.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0894-7317 1097-6795 1097-6795 |
| DOI | 10.1016/j.echo.2019.05.025 |
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| Abstract | 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.
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.
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.
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.
•3215 normal echo studies were collected from healthy children ≤18 years of age.•17% had abnormal blinded core lab calculated values for LV SF <25% and/or EF <50%.•Those with abnormal SF/EF were significantly younger and smaller.•Repeat expert measurements of LV size showed good interobserver reproducibility.•Calculated LV functional indices, however, revealed significant variability. |
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| AbstractList | 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.BACKGROUNDThe 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.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.METHODSThe 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.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.RESULTSOf 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.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.CONCLUSIONSAlthough 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. 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. 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. 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. 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. •3215 normal echo studies were collected from healthy children ≤18 years of age.•17% had abnormal blinded core lab calculated values for LV SF <25% and/or EF <50%.•Those with abnormal SF/EF were significantly younger and smaller.•Repeat expert measurements of LV size showed good interobserver reproducibility.•Calculated LV functional indices, however, revealed significant variability. BackgroundThe 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. MethodsThe 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. ResultsOf 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. ConclusionsAlthough 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. 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. 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. 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. 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 | Toomey, Christiana Williams, Richard V. Krischer, Jeffrey P. Clark, Laurie J. Tierney, E. Seda Slorach, Cameron Triedman, John Shearrow, Marian E. Pignatelli, Ricardo Winrich, Barbara Spurney, Christopher Mital, Seema Otto, Michelle Markham, Larry Hartsig, Hannah Artman, Michael Feltes, Timothy Stylianou, Mario Pucillo, Michelle Frommelt, Peter C. Frommelt, Michele A. Minich, L. LuAnn Atz, Andrew M. Thankavel, Poonam Punjwani Trachtenberg, Felicia Kugler, John Richmond, Marc Duffy, Elise Srivastava, Shubhika Swan, Liz Pemberton, Victoria McCrindle, Brian Lewin, Mark Langley, Susanne Welch, Suzanne Lytrivi, Irene Goldberg, David Driscoll, David Paridon, Stephen McBride, Patrick Ortiz, Janet Hunsberger, Sally Chowdhury, Shahryar Mahle, William Hamstra, Michelle Payne, Mark Levine, Jami Burns, Kristin Johnson, Tiffanie R. Goldberg, Caren Cohen, Meryl S. Cohen, Meryl Colan, Steven D. Van't Hof, Kathleen Pearson, Gail Friedman, Heather S. Lai, Wyman Taylor, Holly Matherne, G. Paul Pober, David Soriano, Brian D. Parra, David A. Taylor, Carolyn Evans, Fr |
| AuthorAffiliation | 17 Seattle Children’s Hospital, Seattle, WA 2 University of Utah, Salt Lake City, UT 14 National Heart, Lung and Blood Institute, NIH, Bethesda, MD 23 University of Michigan, Ann Arbor, MI 3 New England Research Institute, Boston, MA 1 Medical College of Wisconsin, Milwaukee, WI 16 Emory University School of Medicine, Atlanta, GA 12 Medical University of South Carolina, Charleston, SC 21 UT Southwestern Medical Center, Dallas, TX 7 Boston Children’s Hospital, Boston, MA 8 Hospital for Sick Children, Toronto, ON, Canada 10 Nationwide Children’s Hospital, Columbus, OH 18 Children’s National Heart Institute, Washington DC, DC 20 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 9 Indiana University, Indianapolis, IN 15 Baylor College of Medicine, Houston, TX 4 Columbia University Medical Center, New York, NY 11 The Children’s Hospital at Montefiore, New York, NY 6 Children’s Hospital of Pennsylvania, Philadelphia, PA 13 Vanderbilt Medical Center, Nashville, TN 5 Northwestern University, Chicago, |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31351792$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Contributor | Toomey, Christiana Slorach, Cameron Triedman, John Winrich, Barbara Pignatelli, Ricardo Mital, Seema Otto, Michelle Markham, Larry Parra, David A Stylianou, Mario Pucillo, Michelle Lambert, Linda M Soslow, Jonathan H Clark, Laurie J Thankavel, Poonam Punjwani Trachtenberg, Felicia LuAnn Minich, L Richmond, Marc Duffy, Elise Swan, Liz Srivastava, Shubhika Pemberton, Victoria McCrindle, Brian Lewin, Mark Shearrow, Marian E Cnota, James F Langley, Susanne Welch, Suzanne Lytrivi, Irene van der Velde, Mary E Friedman, Heather S Goldberg, David Paridon, Stephen Ortiz, Janet Chowdhury, Shahryar Mahle, William Hamstra, Michelle Payne, Mark Levine, Jami Burns, Kristin Goldberg, Caren Cohen, Meryl Van't Hof, Kathleen Pearson, Gail Lai, Wyman Pober, David Taylor, Carolyn Garuba, David Altman, Carolynn Chen, Shan Granger, Suzanne Stark, Paul Walter, Patricia Stanton, Belva Morrison, Andrew Atz, Andrew M Ohye, Richard Moine, Stephanie Anderson, Brett Sticka, Joshua Lin, Lina Colan, Steven Ni, Brenda Newburger, Jane Frommelt, Michele Sable, Craig Ash, Kathleen Cord |
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| Copyright | 2019 American Society of Echocardiography American Society of Echocardiography Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. |
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| References | Lee, Margossian, Sleeper, Canter, Chen, Tani (bib6) 2014; 35 Lytrivi, Bhatla, Ko, Yau, Geiger, Walsh (bib14) 2011; 24 Cantinotti, Giordano, Scalese, Murzi, Assanta, Spadoni (bib3) 2017; 69 Lopez, Colan, Stylianou, Granger, Trachtenberg, Frommelt (bib11) 2017; 10 Selamet Tierney, Hollenbeck-Pringle, Lee, Altmann, Dunbar-Masterson, Golding (bib4) 2017; 10 Margossian, Chen, Sleeper, Tani, Shirali, Golding (bib7) 2015; 28 Nielsen, Lytrivi, Ko, Bhatla, Parness, Srivastava (bib13) 2010; 27 Norgård, Johannessen (bib8) 1993; 13 Geelhoed, Snijders, Kleyburg-Linkers, Steegers, van Osch-Gevers, Jaddoe (bib18) 2009; 19 Pettersen, Du, Skeens, Humes (bib2) 2008; 21 Captur, Muthurangu, Cook, Flett, Wilson, Barison (bib16) 2013; 15 Sluysmans, Colan (bib1) 2005; 99 Lopez, Colan, Frommelt, Ensing, Kendall, Younoszai (bib12) 2010; 23 Colan, Shirali, Margossian, Gallagher, Altmann, Canter (bib5) 2012; 25 Malm, Frigstad, Sagberg, Larsson, Skjaerpe (bib20) 2004; 44 Nayyar, Magalski, Khumri, Idupulapati, Stoner, Kusnetzky (bib19) 2006; 98 Lipshultz, Easley, Orav, Kaplan, Starc, Bricker (bib9) 2001; 104 Gati, Chandra, Bennett, Reed, Kervio, Panoulas (bib15) 2013; 99 Maret, Brudin, Lindstrom, Nylander, Ohlsson, Engvall (bib17) 2008; 6 Colan (bib10) 2015 Captur (10.1016/j.echo.2019.05.025_bib16) 2013; 15 Geelhoed (10.1016/j.echo.2019.05.025_bib18) 2009; 19 Malm (10.1016/j.echo.2019.05.025_bib20) 2004; 44 Colan (10.1016/j.echo.2019.05.025_bib10) 2015 Cantinotti (10.1016/j.echo.2019.05.025_bib3) 2017; 69 Lopez (10.1016/j.echo.2019.05.025_bib12) 2010; 23 Lee (10.1016/j.echo.2019.05.025_bib6) 2014; 35 Colan (10.1016/j.echo.2019.05.025_bib5) 2012; 25 Lopez (10.1016/j.echo.2019.05.025_bib11) 2017; 10 Lipshultz (10.1016/j.echo.2019.05.025_bib9) 2001; 104 Nielsen (10.1016/j.echo.2019.05.025_bib13) 2010; 27 Nayyar (10.1016/j.echo.2019.05.025_bib19) 2006; 98 Sluysmans (10.1016/j.echo.2019.05.025_bib1) 2005; 99 Norgård (10.1016/j.echo.2019.05.025_bib8) 1993; 13 Lytrivi (10.1016/j.echo.2019.05.025_bib14) 2011; 24 Pettersen (10.1016/j.echo.2019.05.025_bib2) 2008; 21 Selamet Tierney (10.1016/j.echo.2019.05.025_bib4) 2017; 10 Gati (10.1016/j.echo.2019.05.025_bib15) 2013; 99 Maret (10.1016/j.echo.2019.05.025_bib17) 2008; 6 Margossian (10.1016/j.echo.2019.05.025_bib7) 2015; 28 |
| References_xml | – volume: 104 start-page: 310 year: 2001 end-page: 316 ident: bib9 article-title: Reliability of multicenter pediatric echocardiographic measurements of left ventricular structure and function: the prospective P(2)C(2) HIV study publication-title: Circulation – volume: 27 start-page: 691 year: 2010 end-page: 695 ident: bib13 article-title: The accuracy of echocardiographic assessment of left ventricular size in children by the 5/6 area x length (bullet) method publication-title: Echocardiography – volume: 24 start-page: 214 year: 2011 end-page: 218 ident: bib14 article-title: Normal values for left ventricular volume in infants and young children by the echocardiographic subxiphoid five-sixth area by length (bullet) method publication-title: J Am Soc Echocardiogr – volume: 10 start-page: e006007 year: 2017 ident: bib4 article-title: Reproducibility of left ventricular dimension versus area versus volume measurements in pediatric patients with dilated cardiomyopathy 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adolescents: an echocardiographic study publication-title: J Am Soc Echocardiogr doi: 10.1016/j.echo.2008.02.006 – volume: 28 start-page: 549 year: 2015 ident: 10.1016/j.echo.2019.05.025_bib7 article-title: The reproducibility and absolute values of echocardiographic measurements of left ventricular size and function in children are algorithm dependent publication-title: J Am Soc Echocardiogr doi: 10.1016/j.echo.2015.01.014 |
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| Snippet | The reliability of left ventricular (LV) systolic functional indices calculated from blinded echocardiographic measurements of LV size has not been tested in a... BackgroundThe reliability of left ventricular (LV) systolic functional indices calculated from blinded echocardiographic measurements of LV size has not been... |
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| SubjectTerms | Cardiovascular Echocardiography Ejection fraction Left ventricle Pediatric Shortening fraction |
| Title | Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S0894731719307631 https://www.clinicalkey.es/playcontent/1-s2.0-S0894731719307631 https://dx.doi.org/10.1016/j.echo.2019.05.025 https://www.ncbi.nlm.nih.gov/pubmed/31351792 https://www.proquest.com/docview/2266337078 https://pubmed.ncbi.nlm.nih.gov/PMC6779514 |
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