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 × 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.
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 × 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.
Authors: S E Lipshultz; K A Easley; E J Orav; S Kaplan; T J Starc; J T Bricker; W W Lai; D S Moodie; G Sopko; M D Schluchter; S D Colan Journal: Circulation Date: 2001-07-17 Impact factor: 29.690
Authors: Mihai Gheorghiade; Kirkwood F Adams; Wendy A Gattis; John R Teerlink; Cesare Orlandi; Christopher M O'Connor Journal: Am Heart J Date: 2003-02 Impact factor: 4.749
Authors: Daphne T Hsu; Victor Zak; Lynn Mahony; Lynn A Sleeper; Andrew M Atz; Jami C Levine; Piers C Barker; Chitra Ravishankar; Brian W McCrindle; Richard V Williams; Karen Altmann; Nancy S Ghanayem; Renee Margossian; Wendy K Chung; William L Border; Gail D Pearson; Mario P Stylianou; Seema Mital Journal: Circulation Date: 2010-07-12 Impact factor: 29.690
Authors: Philip Thaler Levy; Mark R Holland; Timothy J Sekarski; Aaron Hamvas; Gautam K Singh Journal: J Am Soc Echocardiogr Date: 2013-07-20 Impact factor: 5.251
Authors: Anitha Parthiban; Jami C Levine; Meena Nathan; Jennifer A Marshall; Girish S Shirali; Stephen D Simon; Steve D Colan; Jane W Newburger; Geetha Raghuveer Journal: Pediatr Cardiol Date: 2015-09-10 Impact factor: 1.655
Authors: Shelby Kutty; David Russell; Ling Li; Rimsha Hasan; Qinghai Peng; Peter C Frommelt; David A Danford Journal: Int J Cardiovasc Imaging Date: 2013-12-10 Impact factor: 2.357
Authors: Saro H Armenian; Melissa M Hudson; Renee L Mulder; Ming Hui Chen; Louis S Constine; Mary Dwyer; Paul C Nathan; Wim J E Tissing; Sadhna Shankar; Elske Sieswerda; Rod Skinner; Julia Steinberger; Elvira C van Dalen; Helena van der Pal; W Hamish Wallace; Gill Levitt; Leontien C M Kremer Journal: Lancet Oncol Date: 2015-03 Impact factor: 41.316
Authors: Shahryar M Chowdhury; Ziyad M Hijazi; John F Rhodes; Saibal Kar; Raj Makkar; Michael Mullen; Qi-Ling Cao; Lazar Mandinov; Jason Buckley; Nicholas P Pietris; Girish S Shirali Journal: Echocardiography Date: 2014-07-22 Impact factor: 1.724
Authors: Elif Seda Selamet Tierney; Jami C Levine; Shan Chen; Timothy J Bradley; Gail D Pearson; Steven D Colan; Lynn A Sleeper; M Jay Campbell; Meryl S Cohen; Julie De Backer; Lin T Guey; Haleh Heydarian; Wyman W Lai; Mark B Lewin; Edward Marcus; Christopher R Mart; Ricardo H Pignatelli; Beth F Printz; Angela M Sharkey; Girish S Shirali; Shubhika Srivastava; Ronald V Lacro Journal: J Am Soc Echocardiogr Date: 2013-04-10 Impact factor: 5.251