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

Area of Science:

• Pediatric Cardiology
• Echocardiography
• Cardiac Imaging

Background:

• Assessing left ventricular (LV) systolic function reliability in children using echocardiography is crucial.
• Previous studies have not extensively evaluated interobserver variability in LV size and function indices in a large pediatric cohort.

Purpose of the Study:

• To estimate interobserver variability in standard measurements of LV size and systolic function in healthy children.
• To assess the reliability of calculated LV systolic functional indices derived from blinded echocardiographic measurements.

Main Methods:

• Utilized the Pediatric Heart Network Normal Echocardiogram Database of healthy children (≤18 years).
• Two independent expert pediatric echocardiographic observers remeasured LV dimensions on a subset of studies, blinded to calculated volumes and indices.
• Calculated LV volumes and systolic functional indices (shortening fraction [SF] and ejection fraction [EF]) were compared between core lab and independent observers.

Main Results:

• High reproducibility was observed for individual LV size parameters (intraclass correlation coefficients: 0.81-0.99).
• Lower reproducibility was found for SF (0.24) and EF (0.56).
• A significant proportion of subjects with normal or abnormal SF/EF values based on core lab measurements were classified differently by independent observers, indicating variability in functional index assessment.

Conclusions:

• Blinded measurements of LV size demonstrate good reproducibility in healthy children.
• Calculated LV functional indices (SF/EF) exhibit significant interobserver variability despite normal systolic function.
• Abnormal LV functional indices were more prevalent in younger, smaller children, suggesting potential clinical implications for repeated measurements and subjective assessments.