Discordance interpretation of left ventricular size between echocardiography and cardiac magnetic resonance in pediatric patients with aortic/mitral regurgitation

Anastasia Barros; Michelle Udine; Chris Spurney; Laura Olivieri; Yue-Hin Loke

doi:10.1007/s10554-024-03073-3

Discordance interpretation of left ventricular size between echocardiography and cardiac magnetic resonance in pediatric patients with aortic/mitral regurgitation

Int J Cardiovasc Imaging. 2024 Mar 23. doi: 10.1007/s10554-024-03073-3. Online ahead of print.

Authors

Anastasia Barros¹, Michelle Udine², Chris Spurney², Laura Olivieri³, Yue-Hin Loke²

Affiliations

¹ Nemours Children's Health, Wilmington, DE, USA. anastasia.barros23@gmail.com.
² Children's National Hospital, Washington, DC, USA.
³ Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.

PMID: 38519822
DOI: 10.1007/s10554-024-03073-3

Abstract

Purpose: This study investigated discordance between echocardiography (echo) and cardiac magnetic resonance (CMR) measurements of the left ventricle (LV) in pediatric patients with aortic and/or mitral regurgitation (AR/MR).

Methods: Retrospective cohort study of pediatric patients. The cohorts were comprised of patients with AR/MR vs. non-AR/MR. Left ventricular end diastolic volume (LVEDV) by CMR and left ventricular internal diameter diastolic (LVIDd) by echo were obtained from clinical reports then echo images were reviewed to remeasure LVEDV by bullet method. Left ventricular internal diameter systolic (LVIDs) and left ventricular ejection fraction (LVEF) measurements by echo and LVEF by CMR were obtained from clinical reports. Fractional shortening (FS%) was recalculated. Z-scores were calculated using normative data. Correlation between echo and CMR LV measurements was assessed using correlation coefficients. Bland-Altman plots assessed bias between imaging modalities. Receiver operator characteristic (ROC) analysis was performed for detection of LV enlargement and LV dysfunction.

Results: AR/MR patients had greater discrepancy in LV size interpretation by Z-score compared to non-AR/MR patients. This discrepancy persisted when the bullet method short axis measurements were incorporated. There was negative bias in echo-based measurements compared to CMR. The diagnostic performance of echo in identifying moderate LV enlargement was worse for AR/MR pediatrics patients.

Conclusion: The discordant interpretation of LV size by echo compared to CMR is worse in pediatric patients with AR/MR when compared to patients without AR/MR even when short axis measurements are incorporated. This finding suggests non-uniform geometrical changes in the LV as it enlarges due to AR/MR.

Keywords: Aortic regurgitation; Cardiac magnetic resonance; Congenital heart disease; Echocardiogram; Left ventricular end diastolic volume; Left ventricular internal diameter diastolic; Mitral regurgitation; Pediatric cardiology; Z-score.