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