The reproducibility and absolute values of echocardiographic measurements of left ventricular size and function in children are algorithm dependent.
BACKGROUND
Several quantification algorithms for measuring left ventricular (LV) size and function are used in clinical and research settings. The aims of this study were to investigate the effects of measurement algorithm and beat averaging on the reproducibility of measurements of the left ventricle and to assess the magnitude of agreement among the algorithms in children with dilated cardiomyopathy.


METHODS
Echocardiograms were obtained in 169 children from eight clinical centers. Inter- and intrareader reproducibility was assessed on measurements of LV volumes using the biplane Simpson, modified Simpson, and 5/6 × area × length (5/6AL) algorithms. Percentage error was calculated as inter- or intrareader difference/mean × 100. Single-beat measurements and the three-beat average (3BA) were compared. Intraclass correlation coefficients were calculated to assess agreement.


RESULTS
Single-beat interreader reproducibility was lowest (percentage error was highest) using biplane Simpson; 5/6AL and modified Simpson were similar but significantly better than biplane Simpson (P < .05). Single-beat intrareader reproducibility was highest using 5/6AL (P < .05). The 3BA improved reproducibility for almost all measures (P < .05). Reproducibility in both single-beat and 3BA values fell with greater LV dilation and systolic dysfunction (P < .05). Intraclass correlation coefficients were >0.95 across measures, although absolute volume and mass values were systematically lower for biplane Simpson compared with modified Simpson and 5/6AL.


CONCLUSIONS
The reproducibility of LV size and functional measurements in children with dilated cardiomyopathy is highest using the 5/6AL algorithm and can be further improved by using the 3BA. However, values derived from different algorithms are not interchangeable.
Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: renee.margossian@cardio.chboston.org.
Renee
R
Margossian
New England Research Institutes, Watertown, Massachusetts.
Shan
S
Chen
New England Research Institutes, Watertown, Massachusetts.
Lynn A
LA
Sleeper
Primary Children's Medical Center and University of Utah, Salt Lake City, Utah.
Lloyd Y
LY
Tani
Medical University of South Carolina, Charleston, South Carolina.
Girish
G
Shirali
The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Fraser
F
Golding
Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Elif Seda
ES
Selamet Tierney
Columbia University Medical Center, New York, New York.
Karen
K
Altmann
Duke University Medical Center, Durham, North Carolina.
Michael J
MJ
Campbell
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Anita
A
Szwast
Washington University School of Medicine, St Louis, Missouri.
Angela
A
Sharkey
The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Elizabeth
E
Radojewski
Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Steven D
SD
Colan
D000293:Adolescent; D000465:Algorithms; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult
Cardiomyopathy; Echocardiography; Pediatric; Reproducibility