Accuracy of Visual Estimation of Left Ventricular Ejection Fraction Compared With Echocardiography in Children

This study compared visual assessments of left ventricular systolic function in children by pediatric physicians with quantitative measurements using the Simpson method.

This was a transverse, cohort study conducted between January and June 2023. Patient's echocardiography were performed by a certified pediatric cardiologist in the presence of 2 pediatricians: a senior pediatric intensivist (S.Z.) and a pediatric resident (A.D.). Both pediatricians had prior training in cardiac ultrasound. Following the visual assessment of the echocardiography, each pediatrician records their evaluation of the left ventricular ejection fraction (LVEF) as a percentage. We compared the visual assessment of LVEF with that obtained with quantitative measurements using the Simpson method by the pediatric cardiologist. Bland-Altman analysis was performed between the pediatrician and the cardiologist's LVEF evaluation. Besides the correlation coefficients ( r ) were calculated.

A total of 136 patients, aged between 0 and 18 years, were enrolled. The mean LVEF measured by the cardiologist was 65.05±14.15. The mean LVEF estimated by the senior pediatrician and the pediatric resident was 64.48±13.59 and 64.87±13.17, respectively. Strong correlations were found between visual estimates by both pediatricians and 2-dimensional LVEF ( r =0.832 and r =0.763 respectively, P <0.001). The bland-Altman plot showed that the mean difference of LVEF determined by 2-dimensional LVEF and eyeballing by a senior pediatric intensivist and the junior pediatrician was 0.57±3.64% and 0.18±4.37%, respectively.

The study suggests that visual assessment of LVEF in children is reliable when conducted by experienced pediatricians familiar with echocardiography. However, the results of this study are primarily applicable to the assessment of normal or near-normal left ventricular function.