A Multicenter Study of Three-dimensional Echocardiographic Evaluation of
Normal Pediatric Left Ventricular Volumes and Function
Background: Three-dimensional echocardiography (3DE) evaluation of left
ventricular (LV) volume and function in pediatrics compares favorably
with cardiac magnetic resonance imaging. The aim of this study was to
establish from a multicenter, normal pediatric z-score values of 3DE
left ventricular volumes and function. Methods: Six hundred and
ninety-eight healthy children (ages 0 to 18 years) were recruited from
five centers. 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
semi-automated quantification. Body surface area (BSA) based z-scores
were generated. Intraobserver and interobserver variability were
calculated using intraclass correlation (ICC) and repeatability
coefficient (RC). Results: Z-scores were generated for ESV, EDV, and SV.
The ICC for intraobserver variability for EDV, ESV, and SV were 0.99,
0.99, and 0.99 respectively. The ICC for interobserver variability for
EDV, ESV, and SV were 0.98, 0.94, and 0.98 respectively. The RC for
intraobserver and interobserver variability for LV EF was 4.39% (95%
CI: 3.01, 5.59) and interobserver was 7.08% (95%CI: 5.51, 8.42).
Conclusions: We report pediatric Z-scores for normal LV volumes using
the semi-automated method from five centers, enhancing its
generalizability. 3DE evaluation of LV volumes and EF in pediatric
patients is highly reproducible.