Congenital heart disease
Comparison of Echocardiographic and Cardiac Magnetic Resonance Imaging Measurements of Functional Single Ventricular Volumes, Mass, and Ejection Fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study)

https://doi.org/10.1016/j.amjcard.2009.03.058Get rights and content

Assessment of the size and function of a functional single ventricle (FSV) is a key element in the management of patients after the Fontan procedure. Measurement variability of ventricular mass, volume, and ejection fraction (EF) among observers by echocardiography and cardiac magnetic resonance imaging (CMR) and their reproducibility among readers in these patients have not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9 ± 3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Interobserver agreement for qualitative grading of ventricular function by echocardiography was modest for left ventricular (LV) morphology (κ = 0.42) and weak for right ventricular (RV) morphology (κ = 0.12). For quantitative assessment, high intraclass correlation coefficients were found for echocardiographic interobserver agreement (LV 0.87 to 0.92, RV 0.82 to 0.85) of systolic and diastolic volumes, respectively. In contrast, intraclass correlation coefficients for LV and RV mass were moderate (LV 0.78, RV 0.72). The corresponding intraclass correlation coefficients by CMR were high (LV 0.96, RV 0.85). Volumes by echocardiography averaged 70% of CMR values. Interobserver reproducibility for the EF was similar for the 2 modalities. Although the absolute mean difference between modalities for the EF was small (<2%), 95% limits of agreement were wide. In conclusion, agreement between observers of qualitative FSV function by echocardiography is modest. Measurements of FSV volume by 2-dimensional echocardiography underestimate CMR measurements, but their reproducibility is high. Echocardiographic and CMR measurements of FSV EF demonstrate similar interobserver reproducibility, whereas measurements of FSV mass and LV diastolic volume are more reproducible by CMR.

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Methods

A detailed description of the design and inclusion and exclusion criteria of the Pediatric Heart Network Fontan Cross-Sectional Study has been published.2 Briefly, subjects aged 6 to 18 years were enrolled from March 2003 through April 2004 at 7 pediatric clinical centers in the United States and Canada. Prospective data collection for each subject occurred within a 3-month period and included health status questionnaires, 2-dimensional and Doppler echocardiography, CMR, exercise, and other

Results

The demographic, anatomic, and image quality data for the echocardiography and CMR groups are listed in Table 1. The groups were similar with respect to age, gender, race, and ventricular type.

Table 2 lists intra- and interobserver agreement for echocardiographic image quality and ventricular function grade. Although the confidence intervals (CIs) are wide, the data suggest that agreement for overall image quality grade was weak, with readers' assessments of quality being concordant less than

Discussion

The results of this study reveal several important findings regarding the noninvasive assessment of FSV size and function. Although the qualitative assessment of LV function by 2-dimensional echocardiography was moderately reproducible between observers, assessment of the right ventricle was poorly reproducible. In contrast, quantitative echocardiographic measures of ventricular volumes were quite reproducible for LV and RV morphologies. Although 2-dimensional echocardiographic measurements

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This study was supported by U01 grants HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, and HL068288 from the National Heart, Lung and Blood Institute, Bethesda, Maryland.

A list of participating institutions and investigators appears in the Appendix.

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