Left Ventricular Dilation: When Pediatric Meet Adult Guidelines

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.