- 作者：Steven D. Colan ; Girish Shirali ; Renee Margossian ; Dianne Gallagher ; Karen Altmann ; Charles Canter ; Shan Chen ; Fraser Golding ; Elizabeth Radojewski ; Michael Camitta ; Michael Carboni ; Jack Rychik ; Mario Stylianou ; Lloyd Y. Tani ; Elif Seda Selamet Tierney ; Yanli Wang ; Lynn A. Sleeper ; Pediatric Heart Network Investigators
- 关键词：Cardiomyopathy ; Ventricular function ; Pediatrics ; Echocardiography ; Reproducibility
- 刊名：Journal of the American Society of Echocardiography
- 出版年：2012
- 出版时间：August, 2012
- 年：2012
- 卷：25
- 期：8
- 页码：842-854.e6
- 全文大小：1165 K
Background
Clinical trials often rely on echocardiographic measures of left ventricular size and function as surrogate end points. However, the quantitative impact of factors that affect the reproducibility of these measures is unknown. To address this issue, the National Heart, Lung, and Blood Institute-funded Pediatric Heart Network designed a longitudinal observational study of children with known or suspected dilated cardiomyopathy aged 0 to 22 years from eight pediatric clinical centers.Methods
Clinical data were collected together with 150 echocardiographic indices of left ventricular size and function. Separate observers performed duplicate echocardiographic imaging. Multiple observers performed measurements from three cardiac cycles to enable assessment of intraobserver and interobserver variability. The impacts of beat averaging (BA), observer type (local vs core), and variable type (areas, calculations, dimensions, slopes, time intervals, and velocities) on measurement reproducibility were studied. The outcome measure was percentage error (100 ¡Á difference/mean).
Results
Of 173 enrolled subjects, 131 met criteria for dilated cardiomyopathy. BA, variable type and observer type all influenced percentage error (P < .0001). Core interobserver percentage error (medians, 11.4 % , 10.2 % , and 9.3 % for BA using one, two, and three beats, respectively) was approximately twice the intraobserver percentage error (medians, 6.3 % , 4.9 % , and 4.2 % for BA using one, two, and three beats, respectively). Slopes and calculated variables exhibited high percentage error despite BA. Chamber dimensions, areas, velocities, and time intervals exhibited low percentage error.
Conclusions
This comprehensive evaluation of quantitative echocardiographic methods will provide a valuable resource for the design of future pediatric studies. BA and a single core lab observer improve the reproducibility of echocardiographic measurements in children with dilated cardiomyopathy. Certain measurements are highly reproducible, while others, despite BA, are poorly reproducible.