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

Altmann, Karen; Johnson, Tiffanie R.; Kovalchin, John P.; Nutting, Arni; Soriano, Brian D.; Statile, Christopher; Tierney, Elif Seda Selamet; Burns, Kristin M.; Kaltman, Jonathan R.; Pearson, Gail D.; Pemberton, Victoria L.; Stylianou, Mario; Mahony, Lynn; Chen, Shan; Colan, Steven D.; Gallagher, Dianne; Gerstenberger, Eric; Gongwer, Russell; Granger, Suzanne; Keosaian, Julia; Langley, Susanne; Lin, Lina; Mansolf, Tammi; Moine, Stephanie; Morrison, A.; Nelson, Katelyn N.; Ni, Brenda; Ortiz, Janet; Pober, David M.; Pucillo, Michelle; Stark, Paul; Toomey, Christiana E.; Trachtenberg, Felicia; Winrich, Barbara; Schwartz, Steven; Golding, Fraser; McCrindle, Brian W.; Dragulescu, Andréea; Radojewski, Elizabeth; Mital, Seema; Walter, P; Slorach, Cameron; Newburger, Jane W.; Triedman, John K.; Prakash, Ashwin; Levine, Jami C.; Paridon, Stephen; Cohen, Meryl S.; Goldberg, David J.; Morrison, Tonia; Atz, Andrew M.; Graham, Eric M.; Taylor, Carolyn; Chowdhury, Shahryar M; Infinger, Patricia; Minich, L. LuAnn; Williams, Richard V.; Truong, Dongngan T.; Lambert, Linda M.; Shearrow, Marian E.; Stanton, Belva; Goldberg, Caren S.; Ohye, Richard G.; Velde, Mary E. van der; Welch, Suzanne; Cnota, James; Hamstra, Michelle S.; Ash, Kathleen; Sticka, Joshua; Payne, Mark; Cordes, Timothy M.; Swan, Liz Stillwaggon; Mahle, William T.; Friedman, Heather S.; Clark, L; Sachdeva, Ritu; Penny, Daniel J.; Pignatelli, Ricardo H.; Garuba, David; Altman, Carolynn; Richmond, Marc E.; Lai, Wyman W.; Korsin, Rosalind; Anderson, Brett R.; Thankavel, Poonam P.; Carron, Hollie; Ginde, Salil; Otto, Michelle; Frommelt, Michele A.; Markham, Larry W.; Parra, David; Soslow, Jonathan H.; Young, Luciana; Camarda, Joseph; Duffy, Elise; Hof, Kathleen Van't; Lewin, Mark B.; Lester, Joel; Bhat, Aarti; Payne, Amy G.; Srivastava, Shubhika; Lytrivi, Irene D.; Ko, H. Helen; Mahgerefteh, Joseph; Lopez, Leo; Balem, Kelly Ann; Sable, Craig; Spurney, Christopher F.; Frommelt, Peter C.; Stelter, Jessica; Hartsig, Hannah; Artman, Michael; Rao, Anu; Eidem, Ben; Matherne, G. Paul; Feltes, Timothy F.; Johnson, Julie; Krischer, Jeffrey P.; McBride, Patrick E.; Kugler, John; Evans, F.J.; Driscoll, David J.; Galantowicz, Mark; Hunsberger, Sally; Knight, Thomas J.; Taylor, Holly L.

doi:10.1016/j.echo.2019.05.025

Cited by 28 publications

(19 citation statements)

References 19 publications

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“…The mean absolute percent difference in 3D LV EF between all centers in our study was 7% with the observed difference of 4.2% if the LV EF was measured at 60%. This is better than the reported 2D LV EF absolute percentage difference of 11.2% in the Pediatric Heart Network study 13 . 3D LV EF has been reported to be more accurate and reproducible than 2D LV EF in adults and children because 3DE does not rely on geometric assumptions and is less affected by acquisition technique such as foreshortening 3,[14][15][16][17][18] .…”

Section: Discussioncontrasting

confidence: 68%

A Multicenter Study of Three-dimensional Echocardiographic Evaluation of Normal Pediatric Left Ventricular Volumes and Function with Automated Versus Semi-Automated Quantification

Jone

Pan

et al. 2020

Preprint

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Background: Three-dimensional echocardiography (3DE) evaluation of left ventricular (LV) volume and function in pediatrics compares favorably with cardiac magnetic resonance imaging. A multicenter trial with automated and semi-automated LV quantification allows for generation of normative data in large pediatric patients. The aims of this study were to evaluate the feasibility and reproducibility of measuring threedimensional echocardiography (3DE) volumes and function in pediatric patients in a multicenter trial; to determine if automated software (without contouring edits) will improve the reproducibility in volume and function analysis; and thus establish normal z score values in this unique population.Methods: Six hundred and ninety-eight healthy children (ages 0 to 18 years) were recruited from 5 centers. Left ventricular (LV) 3DE was acquired from the 4-chamber view. A vendor independent software analyzed end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using automated and semi-automated quantification. Feasibility and reproducibility were assessed. Body surface area (BSA) based z-scores were generated.Results: Feasibility was 79% (523/658). Reproducibility was good between centers using the semiautomated quantification. Reproducibility was decreased using the automated quantification. Therefore, Z-scores were generated for ESV, EDV, and SV using the semi-automated method.Conclusions: 3DE can reliably evaluate LV volumes and EF in pediatric patients at different centers. We report pediatric Z-scores for normal LV volumes using the semi-automated method. Further optimization of technology will be necessary for reliable use of fully automated quantification by 3DE in children.

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Section: Discussioncontrasting

confidence: 68%

A Multicenter Study of Three-dimensional Echocardiographic Evaluation of Normal Pediatric Left Ventricular Volumes and Function with Automated Versus Semi-Automated Quantification

Jone

Pan

et al. 2020

Preprint

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“…As such, we chose to apply an a priori cutoff to classify a cohort of critically ill children with at least moderate LV systolic dysfunction. In an effort to avoid potential misclassification of children with minimal LV dysfunction due to inherent variability in LVEF measurement ( 21 ), SAMD was defined a priori as LVEF less than 45%. In contrast to LVEF, strain indices vary significantly by body surface area (BSA) and, thus, age ( 22 , 23 ).…”

Section: Methodsmentioning

confidence: 99%

Myocardial Dysfunction Is Independently Associated With Mortality in Pediatric Septic Shock

Lautz

Wong

Ryan

et al. 2020

Critical Care Explorations

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“…Although echocardiographic ejection fraction (EF) and shortening fraction (SF) have traditionally served to monitor left ventricular systolic function and guide clinical judgement during and after cancer-related therapies, both EF and SF are influenced by ventricular preload and afterload and may not reflect ventricular contractility as much as they represent ventricular remodeling [ 7 ]. Additionally, SF and EF are operator dependent and rely on geometric assumptions, with poor reproducibility reported in a large multi-center study of healthy pediatric patients [ 8 ]. Assessment of tissue deformation by speckle tracking echocardiography may better assess left ventricular contractility with good reproducibility [ 9 ], and although influenced by afterload, has demonstrated the ability to detect subclinical dysfunction after cancer treatment in both pediatric and adult patients [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic myocardial strain analysis describes subclinical cardiac dysfunction after craniospinal irradiation in pediatric and young adult patients with central nervous system tumors

et al. 2021

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Background Craniospinal irradiation (CSI) is part of the treatment of central nervous system (CNS) tumors and is associated with cardiovascular disease in adults. Global myocardial strain analysis including longitudinal peak systolic strain (GLS), circumferential peak systolic strain (GCS), and radial peak systolic strain (GRS) can reveal subclinical cardiac dysfunction. Methods Retrospective, single-center study in patients managed with CSI vs. age-matched controls. Clinical data and echocardiography, including myocardial strain analysis, were collected at early (< 12 months) and late (≥ 12 months) time points after completion of CSI. Results Echocardiograms were available at 20 early and 34 late time points. Patients at the late time point were older (21.7 ± 10.4 vs. 13.3 ± 9.6 years) and further out from CSI (13.1 ± 8.8 vs. 0.2 ± 0.3 years). Standard echocardiographic parameters were normal for both groups. For early, CSI vs. control: GLS was − 16.8 ± 3.6% vs. -21.3 ± 4.0% (p = 0.0002), GCS was − 22.5 ± 5.2% vs. -21.3 ± 3.4% (p = 0.28), and GRS was 21.8 ± 11.0% vs. 26.9 ± 7.7% (p = 0.07). For late, CSI vs. control: GLS was − 16.2 ± 5.4% vs. -21.6 ± 3.7% (p < 0.0001), GCS was − 20.9 ± 6.8% vs. -21.9 ± 3.5% (p = 0.42), and GRS was 22.5 ± 10.0% vs. 27.3 ± 8.3% (p = 0.03). Radiation type (proton vs. photon), and radiation dose (< 30 Gy vs. ≥ 30 Gy) did not impact any parameter, although numbers were small. Conclusions Subclinical cardiac systolic dysfunction by GLS is present both early and late after CSI. These results argue for future studies to determine baseline cardiovascular status and the need for early initiation of longitudinal follow-up post CSI.

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

Cited by 28 publications

References 19 publications

A Multicenter Study of Three-dimensional Echocardiographic Evaluation of Normal Pediatric Left Ventricular Volumes and Function with Automated Versus Semi-Automated Quantification

A Multicenter Study of Three-dimensional Echocardiographic Evaluation of Normal Pediatric Left Ventricular Volumes and Function with Automated Versus Semi-Automated Quantification

Myocardial Dysfunction Is Independently Associated With Mortality in Pediatric Septic Shock

Echocardiographic myocardial strain analysis describes subclinical cardiac dysfunction after craniospinal irradiation in pediatric and young adult patients with central nervous system tumors

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