Journal of the American Society of Echocardiography
Clinical InvestigationFetal and Pediatric EchocardiographyChallenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database
Section snippets
Methods
The PHN Normal Echocardiogram Database collected echocardiographic images from healthy children ≤18 years old enrolled at 19 clinical sites and distributed equally by age, gender, and race categories.11 All images were deidentified and digitally transferred to a pediatric echocardiography research core lab at Children's Hospital of Wisconsin, where two-dimensional (2D) measurements of cardiac, valvular, and vascular sizes were performed using established American Society of Echocardiography
Results
Of the 3,215 subjects with measurable echocardiographic images enrolled in the PHN Normal Echocardiogram Database, calculations based on core lab measurements showed that 552 (17%) had an SF < 25% (n = 415; 13%) and/or an EF <50% (n = 291; 9%); 154 subjects (5%) belonged to both groups. Compared with the 2,663 subjects with normal LV functional parameters, the subjects with abnormal SF and/or EF were younger (median age, 4.02 vs 7.13 years; P < .001), smaller (body surface area median, 0.70 vs
Discussion
This unique study demonstrated that echocardiograms from healthy children with qualitatively normal LV systolic function can be interpreted as having abnormal function when blindly assessed using 2D measurements of LV size without knowledge of the calculated SF or EF. In addition, calculated indices of LV systolic function, mass, and shape using these measurements showed significant interobserver variability and mean absolute differences, even though 2D parameters of LV size were measured
Conclusion
Although 2D measurements of LV size show good reproducibility, calculated LV systolic functional indices from blinded measurements reveal significant variability such that abnormal LV SF and LV EF values can be associated with normal echocardiographic studies from healthy children despite qualitatively normal systolic function. This suggests that, in clinical practice, abnormal SF/EF values may result in repeat local measurements of LV size to match the subjective assessment of function prior
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2020, Progress in Pediatric CardiologyCitation Excerpt :Conventional echocardiographic approaches include 2-dimensional echocardiography, M-mode, pulsed Doppler, and color Doppler studies. Lopez et al. described standards of quantification of ventricular function [1], and a recent publication by Frommelt et al. questioned the reliability in standard 2--dimensional echocardiographic methods of quantitation of ventricular function [2]. Shortening fraction and ejection fraction are geometric parameters that characterize dimensional or volumetric changes during the cardiac cycle [3].
A list of all Pediatric Heart Network Investigators is provided in the Supplementary Materials.
This research was supported by grants (HL068270, HL068290, HL109673, HL109737, HL109741, HL109743, HL109777, HL109778, HL109781, HL109816, and HL109818) from the National Heart, Lung, and Blood Institute, National Institutes of Health.
Conflicts of Interest: No financial disclosures. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the National Heart, Lung, and Blood Institute.