Real-Time Three-Dimensional Echocardiography of the Left Ventricle-Pediatric Percentiles and Head-to-Head Comparison of Different Contour-Finding Algorithms: A Multicenter Study

Kristina Krell; Kai Thorsten Laser; Robert Dalla-Pozza; Christian Winkler; Ursula Hildebrandt; Deniz Kececioglu; Johannes Breuer; Ulrike Herberg

doi:10.1016/j.echo.2018.01.018

Real-Time Three-Dimensional Echocardiography of the Left Ventricle-Pediatric Percentiles and Head-to-Head Comparison of Different Contour-Finding Algorithms: A Multicenter Study

J Am Soc Echocardiogr. 2018 Jun;31(6):702-711.e13. doi: 10.1016/j.echo.2018.01.018. Epub 2018 Mar 28.

Authors

Kristina Krell¹, Kai Thorsten Laser², Robert Dalla-Pozza³, Christian Winkler¹, Ursula Hildebrandt¹, Deniz Kececioglu², Johannes Breuer¹, Ulrike Herberg⁴

Affiliations

¹ Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany.
² Department of Congenital Heart Defects, Heart and Diabetes Center, North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.
³ Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Munich, Germany.
⁴ Department of Pediatric Cardiology, Children's Hospital, University of Bonn, Bonn, Germany. Electronic address: ulrike.herberg@ukb.uni-bonn.de.

PMID: 29605473
DOI: 10.1016/j.echo.2018.01.018

Abstract

Background: Real-time three-dimensional echocardiography (RT3DE) is a promising method for accurate assessment of left ventricular (LV) volumes and function, however, pediatric reference values are scarce. The aim of the study was to establish pediatric percentiles in a large population and to compare the inherent influence of different evaluation software on the resulting measurements.

Methods: In a multicenter prospective-design study, 497 healthy children (ages 1 day to 219 months) underwent RT3DE imaging of the LV (ie33, Philips, Andover, MA). Volume analysis was performed using QLab 9.0 (Philips) and TomTec 4DLV2.7 (vendor-independent; testing high (TomTec₇₅) and low (TomTec₃₀) contour-finding activity). Reference percentiles were computed using Cole's LMS method. In 22 subjects, cardiovascular magnetic resonance imaging (CMR) was used as the reference.

Results: A total of 370/497 (74.4%) of the subjects provided adequate data sets. LV volumes had a significant association with age, body size, and gender; therefore, sex-specific percentiles were indexed to body surface area. Intra- and interobserver variability for both workstations was good (relative bias ± SD for end-diastolic volume [EDV] in %: intraobserver: QLab = -0.8 ± 2.4; TomTec₃₀ = -0.7 ± 7.2; TomTec₇₅ = -1.9 ± 6.7; interobserver: QLab = 2.4 ± 7.5; TomTec₃₀ = 1.2 ± 5.1; TomTec₇₅ = 1.3 ± 4.5). Intervendor agreement between QLab and TomTec₃₀ showed larger bias and wider limits of agreement (bias: QLab vs TomTec₃₀: end-systolic volume [ESV] = 0.8% ± 23.6%; EDV = -2.2% ± 17.0%) with notable individual differences in small children. QLab and TomTec underestimated CMR values, with the highest agreement between CMR and QLab.

Conclusions: RT3DE allows reproducible noninvasive assessment of LV volumes and function. However, intertechnique variability is relevant. Therefore, our software-specific percentiles, based on a large pediatric population, serve as a reference for both commonly used quantification programs.

Keywords: 3D echocardiography; Children; Left heart; Nomogram; Pediatric; Volumetry.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Algorithms*
Child
Child, Preschool
Echocardiography, Three-Dimensional / methods*
Female
Follow-Up Studies
Heart Ventricles / diagnostic imaging*
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging, Cine
Male
Prospective Studies
ROC Curve
Reference Values
Reproducibility of Results
Stroke Volume / physiology*
Ventricular Function, Left / physiology*