Department of Pediatric Nephrology, Emma Children's Hospital Academic Medical Center, Amsterdam, Netherlands.
BMC Nephrol. 2013 Aug 2;14:170. doi: 10.1186/1471-2369-14-170.
Monitoring of the appearance of left ventricular hypertrophy (LVH) by echocardiography is currently recommended for in the management of children with End-stage renal disease (ESRD). In order to investigate the validity of this method in ESRD children, we assessed the intra- and inter-observer reproducibility of the diagnosis LVH.
Echocardiographic measurements in 92 children (0-18 years) with ESRD, made by original analysists, were reassessed offline, twice, by 3 independent observers. Smallest detectable changes (SDC) were calculated for continuous measurements of diastolic interventricular septum (IVSd), Left ventricle posterior wall thickness (LVPWd), Left ventricle end-diastolic diameter (LVEDd), and Left ventricle mass index (LVMI). Cohen's kappa was calculated to assess the reproducibility of LVH defined in two different ways. LVH(WT) was defined as Z-value of IVSd and/or LVPWd>2 and LVH(MI) was defined as LVMI> 103 g/m² for boys and >84 g/m² for girls.
The intra-observer SDCs ranged from 1.6 to 1.7 mm, 2.0 to 2.6 mm and 17.7 to 30.5 g/m² for IVSd, LVPWd and LVMI, respectively. The inter-observer SDCs were 2.6 mm, 2.9 mm and 24.6 g/m² for IVSd, LVPWd and LVMI, respectively. Depending on the observer, the prevalence of LVH(WT) and LVH(MI) ranged from 2 to 30% and from 8 to 25%, respectively. Kappas ranged from 0.4 to 1.0 and from 0.1 to 0.5, for intra-and inter- observer reproducibility, respectively.
Changes in diastolic wall thickness of less than 1.6 mm or LVMI less than 17.7 g/m² cannot be distinguished from measurement error in individual children, even when measured by the same observer. This limits the use of echocardiography to detect changes in wall thickness in children with ESRD in routine practice.
目前建议通过超声心动图监测左心室肥厚（LVH）的出现，以对终末期肾病（ESRD）患儿进行管理。为了研究该方法在 ESRD 患儿中的有效性，我们评估了 LVH 诊断的观察者内和观察者间可重复性。
对 92 名 ESRD 患儿（0-18 岁）的超声心动图测量值，由原始分析人员进行测量，由 3 名独立观察者离线进行两次重新评估。计算舒张期室间隔（IVSd）、左心室后壁厚度（LVPWd）、左心室舒张末期直径（LVEDd）和左心室质量指数（LVMI）的连续测量的最小可检测变化（SDC）。计算 Cohen's kappa 以评估两种不同方法定义的 LVH 的可重复性。LVH（WT）定义为 IVSd 和/或 LVPWd 的 Z 值>2，LVH（MI）定义为男孩的 LVMI>103 g/m²和女孩的>84 g/m²。
观察者内的 SDC 范围分别为 1.6 至 1.7 毫米、2.0 至 2.6 毫米和 17.7 至 30.5 g/m²，用于 IVSd、LVPWd 和 LVMI。观察者间的 SDC 分别为 2.6 毫米、2.9 毫米和 24.6 克/m²，用于 IVSd、LVPWd 和 LVMI。根据观察者的不同，LVH（WT）和 LVH（MI）的患病率范围分别为 2%至 30%和 8%至 25%。Kappa 值分别为 0.4 至 1.0 和 0.1 至 0.5，用于观察者内和观察者间的可重复性。
即使由同一观察者测量，个体儿童的舒张壁厚度变化小于 1.6 毫米或 LVMI 小于 17.7 g/m²，也无法与测量误差区分开来。这限制了超声心动图在常规实践中用于检测 ESRD 患儿壁厚度变化的用途。
