Aisling Smith1, Jyothsna R Purna2, Michael P Castaldo3, Daniel Ibarra-Rios4, Regan E Giesinger5, Danielle R Rios6, Dany E Weisz2, Amish Jain2, Afif F El-Khuffash1,7, Patrick J McNamara5. 1. Department of Neonatology, The Rotunda Hospital, Dublin, Ireland. 2. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. 3. Department of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada. 4. Hospital Infantil de Mexico Federico Gomez, Mexico, Mexico. 5. Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA. 6. Texas Children's Hospital, Houston, Texas, USA. 7. Royal College of Surgeons in Ireland, Dublin, Ireland.
Abstract
BACKGROUND: Subjective assessment of right ventricular (RV) function by neonatal echocardiography lacks validation. Incorrect diagnostic assignment in patients with suspected pulmonary hypertension (PH) may lead to unnecessary treatment or missed treatment opportunities. METHODS: Six evaluators (experts [n = 3], novice [n = 3]) were asked to independently rate RV characteristics (global function, dilation, and septal flattening) based on standardized echocardiography images. We randomly selected 60 infants, ≥35 weeks gestation at birth, of whom 30 were clinically unwell with acute pulmonary hypertension (aPH) and 30 were healthy controls. aPH was defined by echocardiography presence of right-left shunting across transitional shunts or elevated right ventricular systolic pressure as estimated by the magnitude of the regurgitant jet across the tricuspid valve with impaired oxygenation. Inter-rater comparative evaluation within groups and between groups was performed using Kappa statistics. RESULTS: Global agreement between evaluators for subjective assessment of RV function (0.3 [0.03], P < 0.001), size (0.14 [0.02], P < 0.001), and septal flattening (0.2 [0.02], P < 0.001) was uniformly poor. Agreement in RV function assessment was marginally better for both expert (0.32 [0.08], P < 0.001 vs 0.13 [0.081], and P < 0.001) and novice (0.4 [0.08], P < 0.001 vs 0.06 [0.07], and P < 0.001) evaluators. Overall, the diagnosis of aPH vs control was misclassified in 18% of cases. CONCLUSION: This study demonstrated significant variability in qualitative assessment of RV size and function by trained evaluators, regardless of level of expertise attained. The reliability of objective measures of RV hemodynamics requires prospective evaluation.
BACKGROUND: Subjective assessment of right ventricular (RV) function by neonatal echocardiography lacks validation. Incorrect diagnostic assignment in patients with suspected pulmonary hypertension (PH) may lead to unnecessary treatment or missed treatment opportunities. METHODS: Six evaluators (experts [n = 3], novice [n = 3]) were asked to independently rate RV characteristics (global function, dilation, and septal flattening) based on standardized echocardiography images. We randomly selected 60 infants, ≥35 weeks gestation at birth, of whom 30 were clinically unwell with acute pulmonary hypertension (aPH) and 30 were healthy controls. aPH was defined by echocardiography presence of right-left shunting across transitional shunts or elevated right ventricular systolic pressure as estimated by the magnitude of the regurgitant jet across the tricuspid valve with impaired oxygenation. Inter-rater comparative evaluation within groups and between groups was performed using Kappa statistics. RESULTS: Global agreement between evaluators for subjective assessment of RV function (0.3 [0.03], P < 0.001), size (0.14 [0.02], P < 0.001), and septal flattening (0.2 [0.02], P < 0.001) was uniformly poor. Agreement in RV function assessment was marginally better for both expert (0.32 [0.08], P < 0.001 vs 0.13 [0.081], and P < 0.001) and novice (0.4 [0.08], P < 0.001 vs 0.06 [0.07], and P < 0.001) evaluators. Overall, the diagnosis of aPH vs control was misclassified in 18% of cases. CONCLUSION: This study demonstrated significant variability in qualitative assessment of RV size and function by trained evaluators, regardless of level of expertise attained. The reliability of objective measures of RV hemodynamics requires prospective evaluation.
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: Nagesh S Anavekar; David Gerson; Hicham Skali; Raymond Y Kwong; E Kent Yucel; Scott D Solomon Journal: Echocardiography Date: 2007-05 Impact factor: 1.724
Authors: Amish Jain; Afif F El-Khuffash; Bart C W Kuipers; Adel Mohamed; Kim A Connelly; Patrick J McNamara; Robert P Jankov; Luc Mertens Journal: J Pediatr Date: 2016-11-28 Impact factor: 4.406
Authors: Amish Jain; Adel Mohamed; Afif El-Khuffash; Kim A Connelly; Frederic Dallaire; Robert P Jankov; Patrick J McNamara; Luc Mertens Journal: J Am Soc Echocardiogr Date: 2014-09-23 Impact factor: 5.251
Authors: Amish Jain; Regan E Giesinger; Shyamala Dakshinamurti; Yasser ElSayed; Robert P Jankov; Dany E Weisz; Satyan Lakshminrusimha; Souvik Mitra; Mjaye L Mazwi; Joseph Ting; Michael Narvey; Patrick J McNamara Journal: J Perinatol Date: 2022-01-11 Impact factor: 3.225