Background

Real-time three-dimensional echocardiography (RT3DE) is a promising method for accurate assessment of left ventricular (LV) volumes and function, however, pediatric reference values are scarce. The aim of the study was to establish pediatric percentiles in a large population and to compare the inherent influence of different evaluation software on the resulting measurements.

Methods

In a multicenter prospective-design study, 497 healthy children (ages 1 day to 219 months) underwent RT3DE imaging of the LV (ie33, Philips, Andover, MA). Volume analysis was performed using QLab 9.0 (Philips) and TomTec 4DLV2.7 (vendor-independent; testing high (TomTec₇₅) and low (TomTec₃₀) contour-finding activity). Reference percentiles were computed using Cole's LMS method. In 22 subjects, cardiovascular magnetic resonance imaging (CMR) was used as the reference.

Results

A total of 370/497 (74.4%) of the subjects provided adequate data sets. LV volumes had a significant association with age, body size, and gender; therefore, sex-specific percentiles were indexed to body surface area. Intra- and interobserver variability for both workstations was good (relative bias ± SD for end-diastolic volume [EDV] in %: intraobserver: QLab = −0.8 ± 2.4; TomTec₃₀ = −0.7 ± 7.2; TomTec₇₅ = −1.9 ± 6.7; interobserver: QLab = 2.4 ± 7.5; TomTec₃₀ = 1.2 ± 5.1; TomTec₇₅ = 1.3 ± 4.5). Intervendor agreement between QLab and TomTec₃₀ showed larger bias and wider limits of agreement (bias: QLab vs TomTec₃₀: end-systolic volume [ESV] = 0.8% ± 23.6%; EDV = −2.2% ± 17.0%) with notable individual differences in small children. QLab and TomTec underestimated CMR values, with the highest agreement between CMR and QLab.

Conclusions

RT3DE allows reproducible noninvasive assessment of LV volumes and function. However, intertechnique variability is relevant. Therefore, our software-specific percentiles, based on a large pediatric population, serve as a reference for both commonly used quantification programs.

中文翻译：

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左心室实时三维超声心动图-小儿百分位数以及不同轮廓查找算法的头对头比较：多中心研究

背景

实时三维超声心动图（RT3DE）是一种准确评估左心室（LV）体积和功能的有前途的方法，但是，儿科参考值很少。该研究的目的是在大量人群中建立儿科百分位，并比较不同评估软件对所得测量结果的内在影响。

方法

在一项多中心前瞻性设计研究中，对497名健康儿童（1天至219个月大）进行了LV的RT3DE成像（即33，Philips，Andover，MA）。使用QLab 9.0（Philips）和TomTec 4DLV2.7（独立于供应商；测试高（TomTec ₇₅）和低（TomTec ₃₀）轮廓发现活动）进行体积分析。参考百分位数是使用Cole的LMS方法计算的。在22名受试者中，心血管磁共振成像（CMR）被用作参考。

结果

共有370/497（74.4％）的受试者提供了足够的数据集。左室容量与年龄，体型和性别密切相关。因此，按性别划分的百分位数与身体表面积有关。两个工作站的观察者之间和观察者之间的变异性都很好（舒张末期容积[EDV]的相对偏差±SD：观察者内部：QLab = -0.8±2.4; TomTec ₃₀  = -0.7±7.2; TomTec ₇₅  = -1.9±6.7 ；观察者之间：QLab = 2.4±7.5； TomTec ₃₀  = 1.2±5.1； TomTec ₇₅  = 1.3±4.5）。QLab与TomTec ₃₀之间的供应商间协议显示出更大的偏见和更大的协议限制（偏见：QLab与TomTec ₃₀：收缩末期容积[ESV] = 0.8％±23.6％；EDV = −2.2％±17.0％），并且在幼儿中存在明显的个体差异。QLab和TomTec低估了CMR值，CMR和QLab之间的一致性最高。

结论

RT3DE允许对左室容积和功能进行可重复的无创评估。但是，技术间的可变性是相关的。因此，我们基于特定儿童群体的特定于软件的百分位数可作为两种常用定量程序的参考。