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Left Ventricular Dilation: When Pediatric Meet Adult Guidelines
Jill Harmon1, Kacy Sisco1, Marc Dutro1
1Heart Center, Nationwide Children's Hospital, Columbus, USA.
Insights
Pediatric echocardiographic readers showed poor agreement with adult guidelines for assessing left ventricular (LV) size. Further standardization is needed for pediatric patients approaching adult dimensions.
Area of Science:
- Cardiology
- Pediatric Echocardiography
- Medical Imaging
Background:
- Accurate measurement of left ventricular (LV) size is crucial for diagnosing and managing cardiovascular conditions.
- Existing guidelines for LV size quantification exist for pediatric and adult patients but their inter-agreement is not well-established.
- Assessing LV dilation is vital for patient prognosis and treatment decisions.
Purpose of the Study:
- To evaluate the agreement between pediatric echocardiographic readers (PER), pediatric guidelines, and adult guidelines in assessing LV dilation.
- To identify discrepancies in LV size grading between different interpretation methods.
- To inform the need for updated or standardized guidelines for LV size assessment in pediatric populations.
Main Methods:
- Retrospective review of 1489 non-congenital echocardiograms with enlarged LV end-diastolic diameter (LVEDD).
- LV size was graded using Z-scores based on pediatric and adult guidelines.
- Agreement analysis was performed between PER interpretations and guideline-based assessments.
Main Results:
- Agreement between PER and pediatric guidelines was 63.91% for males and 81.8% for females.
- Agreement between PER and adult guidelines was significantly lower: 39.14% for males and 14.13% for females.
- Agreement between adult and pediatric guidelines was also poor: 41.44% for males and 14.49% for females.
- These agreement levels remained consistent across age cohorts.
Conclusions:
- Pediatric echocardiographic readers demonstrated better adherence to pediatric guidelines than adult guidelines.
- Significant discordance exists between pediatric and adult guidelines, and between readers and adult guidelines, in assessing LV size.
- There is a clear need for improved standardization and updated guidelines for assessing LV size in pediatric patients, particularly those with adult-like dimensions.
Abstract:
Measuring and grading left ventricular (LV) size is essential for diagnostic, treatment, and prognostic purposes. Guidelines for quantifying LV size exist for pediatric and adult patients via M-mode measurements, but no data exist determining how well they agree with one another. The goal of this study was to determine the agreement between pediatric echocardiographic readers (PER), pediatric guidelines, and adult guidelines in assessing LV dilation. A retrospective review of all noncongenital echocardiograms from 9/2002 to 11/2015 that had a left ventricular end-diastolic diameter (LVEDD) >5.8 cm for males and >5.2 cm for females was performed. LV size was graded as normal (Z-score ≤ 2), mild (2 < Z-score ≤ 3), moderate (3 < Z-score ≤ 4), or severe (4 < Z-score) based on pediatric and adult guidelines. PER interpretation was also recorded. Agreement between LV size assessments was determined for these three interpretations. A total of 1489 echocardiograms met the inclusion criteria (654 males:835 females). Males were 19.0 ± 6.9 years old and had a BSA of 1.9 ± 0.3 m2, and LVEDD was 6.3 ± 0.5 cm. Females were 18.7 ± 8.3 years old and had a BSA of 1.8 ± 0.3 m2, and LVEDD was 5.7 ± 0.5 cm. There was a 63.91% agreement for males and an 81.8% agreement for females between PER and pediatric guidelines in assessing LV size. There was a 39.14% agreement for males and a 14.13% agreement for females between PER and adult guidelines in assessing LV size. There was a 41.44% agreement for males and a 14.49% agreement for females between adult and pediatric guidelines in assessing LV size. These agreement percentages did not change significantly when separating the population into greater than or less than 18 years of age cohorts. Pediatric echocardiographic readers were more consistent in following pediatric guidelines than adult guidelines in assessing LV size. The agreement for PER and pediatric guidelines was poor, especially for females, in relation to adult guidelines when assessing LV size. Further standardization and guidelines are needed for pediatric patients that are adult size.
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