Thorac Cardiovasc Surg 2018; 66(S 02): S111-S138
DOI: 10.1055/s-0038-1628332
Short Presentations
Sunday, February 18, 2018
DGPK: Imaging in Pediatric Cardiology
Georg Thieme Verlag KG Stuttgart · New York

Pediatric Left Ventricular Volumetry Using Real-time Three-dimensional Echocardiography: Validation and Multicenter Reference Values Based on High Sample Size

S. Glezou
1   Department of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
,
U. Herberg
2   Department of Pediatric Cardiology, Children’s Hospital, University of Bonn, Bonn, Germany
,
H. Körperich
3   Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
,
P. Barth
3   Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
,
W. Burchert
3   Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
,
D. Kececioglu
1   Department of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
,
R. Pozza Dalla
4   Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Munich, Germany
,
K.T. Laser
1   Department of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objectives: Quick and accurate functional assessment of the left ventricle (LV) is essential to evaluate young patients with congenital heart disease (CHD). In comparison to the gold standard cardiac magnetic resonance (CMR) real-time three-dimensional echocardiography (RT3DE) is getting more precise, is quick, cost-efficient and convenient especially in very young patients. As there are differences in quantification strategy between quantification softwares, validation should precede the calculation of reference values.

Methods: A cohort of 39 subjects (n = 17 healthy children and n = 22 patients with CHD) consecutively underwent CMR (3-T TX Achieva, 25 cardiac phases/slice) and RT3DE (IE 33, Vivid E9, four subvolumes). After quantification of end-diastolic and end-systolic volumes (EDV, ESV) using dedicated software (CMR: HDZ MR-Tools, RT3DE: 4D LV-Analysis 3.1 software [Tomtec]), results were compared using Bland-Altman statistics. In a multicenter design 376 RT3DE datasets of healthy children (188 females) were analyzed for generation of centiles.

Results: LV volumes, both EDV (EDV: 17 ± 14%, LOA (limits of agreement): −11 to 45%, r = 0.96) and ESV (ESV: 14.8 ± 23.7%, LOA −32.5 to 62.1%, r = 0.913), showed a slight but significant underestimation by RT3DE in comparison to CMR resulting in excellent agreement of ejection fraction (EF: 0.5 ± 10.7%, LOA: −20.9 to 21.8). Reproducibility was promising (intraobserver variability: EDV: 2.5 ± 10.1%, LOA: −17.7 to 22.8%, ICC [intraclass correlation coefficient] 0.959, ESV: −0.3 ± 13.4%, LOA: −27.2 to 26.6%, ICC 0.939, interobserver variability: EDV: 1.1 ± 11.5%, LOA: −21.8 to 24%, ICC 0.946, ESV: −2.1 ± 19%, LOA: −40 to 35.9%, ICC: 0.862). Quality of datasets and intensive interoperator training for RT3DE analysis was necessary to obtain this accuracy of the analyses. Mean calculation time was 5 minutes.

Conclusion: RT3DE offers quick and accurate evaluation of LV volumes with slight underestimation of volumes and is therefore appropriate for the investigation of patients with CHD. The centile curves provide a helpful tool in the clinical context of follow-up studies in the maturating heart.