title: A modified echocardiographic approach improves reliability of superior vena caval flow quantification.
abstract: OBJECTIVE
  To assess accuracy and repeatability of a modified echocardiographic approach to quantify superior vena cava (SVC) flow volume that uses a short-axis view to directly measure SVC area and a suprasternal view to measure flow velocity, both at the level of the right pulmonary artery.
  
  
  METHODS
  Three tertiary-level neonatal intensive care units.
  
  
  METHODS
  This was a multicentre, prospective, observational study. Accuracy of the traditional and modified approach was first assessed by comparing echo measurements according to both techniques with Phase contrast MRI (PCMRI) assessments, in a cohort of 10 neonates. In a second cohort of 40 neonates, intraobserver scan-rescan repeatability and interobserver analysis-reanalysis repeatability were assessed by repeated SVC flow echo measurements, according to both techniques.
  
  
  RESULTS
  The traditional echocardiographic approach to assessment of SVC flow had a moderate agreement with PCMRI (r20.259), a scan-rescan intraobserver repeatability index (RI) of 37% (limits of agreement (LOA) -47/+51 mL/kg/min) and an interobserver analysis-reanalysis RI of 31% (LOA -38/+40 mL/kg/min). The modified approach showed a stronger agreement with PCMRI (r20.775), an improved intraobserver scan-rescan repeatability (RI 22%, LOA -24/+18 mL/kg/min) and improved interobserver analysis-reanalysis repeatability (RI 18%, LOA -18/+20 mL/kg/min).
  
  
  CONCLUSIONS
  Echocardiographic assessment of SVC flow volume by tracing area from a short-axis view and measuring velocity-time integral from a suprasternal view offered an improvement in accuracy and repeatability, building on the traditional approach previously described.
authors.affiliation: Neonatal Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.|Imperial College and MRC Clinical Sciences Centre, Queen Charlotte's and Chelsea Hospital, London, UK.
authors.forename: Benjamim
authors.initials: B
authors.lastname: Ficial
authors.affiliation: Neonatal Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bonafiglia
authors.affiliation: Neonatal Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
authors.forename: Ezio M
authors.initials: EM
authors.lastname: Padovani
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Prioli
authors.affiliation: Imperial College and MRC Clinical Sciences Centre, Queen Charlotte's and Chelsea Hospital, London, UK.|Division of Imaging Sciences and Biomedical Engineering, The Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Finnemore
authors.affiliation: Imperial College and MRC Clinical Sciences Centre, Queen Charlotte's and Chelsea Hospital, London, UK.|Division of Imaging Sciences and Biomedical Engineering, The Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cox
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Broadhouse
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Price
authors.affiliation: Imperial College and MRC Clinical Sciences Centre, Queen Charlotte's and Chelsea Hospital, London, UK.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Durighel
authors.affiliation: Division of Newborn Medicine, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Alan M
authors.identifier: http://orcid.org/0000-0002-6118-0477
authors.initials: AM
authors.lastname: Groves
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology*; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: Cardiology; Intensive Care; Neonatology