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

Pediatric Heart Network Investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1331-1338.e1
JournalJournal of the American Society of Echocardiography
Volume32
Issue number10
DOIs
StatePublished - Oct 2019

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Databases
Pediatrics
Observer Variation
Stroke Volume
Anatomy
Reference Values

Keywords

  • Echocardiography
  • Ejection fraction
  • Left ventricle
  • Pediatric
  • Shortening fraction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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

In: Journal of the American Society of Echocardiography, Vol. 32, No. 10, 10.2019, p. 1331-1338.e1.

Research output: Contribution to journalArticle

@article{da206ee3ab164f2d8897c8ed9300fcc7,
title = "Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database",
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",
author = "{Pediatric Heart Network Investigators} and Frommelt, {Peter C.} and Minich, {L. Lu Ann} and Trachtenberg, {Felicia L.} and Karen Altmann and Joseph Camarda and Cohen, {Meryl S.} and Colan, {Steven D.} and Andreea Dragulescu and Frommelt, {Michele A.} and Johnson, {Tiffanie R.} and Kovalchin, {John P.} and Lina Lin and Joseph Mahgerefteh and Arni Nutting and Parra, {David A.} and Pearson, {Gail D.} and Ricardo Pignatelli and Ritu Sachdeva and Soriano, {Brian D.} and Christopher Spurney and Shubhika Srivastava and Statile, {Christopher J.} and Jessica Stelter and Mario Stylianou and Thankavel, {Poonam P.} and Tierney, {E. Seda} and {van der Velde}, {Mary E.} and Leo Lopez and Kristin Burns and Jonathan Kaltman and Gail Pearson and Victoria Pemberton and Lynn Mahony and Shan Chen and Steven Colan and Dianne Gallagher and Eric Gerstenberger and Russell Gongwer and Suzanne Granger and Julia Keosaian and Susanne Langley and Tammi Mansolf and Stephanie Moine and Andrew Morrison and Katelyn Nelson and Brenda Ni and Janet Ortiz and David Pober and Michelle Pucillo and Paul Stark",
year = "2019",
month = "10",
doi = "10.1016/j.echo.2019.05.025",
language = "English (US)",
volume = "32",
pages = "1331--1338.e1",
journal = "Journal of the American Society of Echocardiography",
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number = "10",

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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

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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U2 - 10.1016/j.echo.2019.05.025

DO - 10.1016/j.echo.2019.05.025

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SP - 1331-1338.e1

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 10

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