扩张型心肌病患儿左心室尺寸、面积与容积测量的可重复性
Reproducibility of Left Ventricular Dimension Versus Area Versus Volume Measurements in Pediatric Patients With Dilated Cardiomyopathy.
作者信息
Selamet Tierney Elif Seda, Hollenbeck-Pringle Danielle, Lee Caroline K, Altmann Karen, Dunbar-Masterson Carolyn, Golding Fraser, Lu Minmin, Miller Stephen G, Molina Kimberly, Natarajan Shobha, Taylor Carolyn L, Trachtenberg Felicia, Colan Steven D
机构信息
From the Department of Pediatrics, Stanford University, Palo Alto, CA (E.S.S.T.); New England Research Institutes, Watertown, MA (D.H.-P., M.L., F.T.); Department of Pediatrics, St. Louis Children's Hospital, Washington University, MO (C.K.L.); Department of Pediatrics, New York Presbyterian Medical Center, Columbia University (K.A.); Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (C.D.-M., S.D.C.); Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada (F.G.); Department of Pediatrics, Duke University School of Medicine, Durham, NC (S.G.M.); Department of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City (K.M.); Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, CA (S.N.); and Department of Pediatrics, Medical University of South Carolina, Children's Hospital of South Carolina, Charleston (C.L.T.).
出版信息
Circ Cardiovasc Imaging. 2017 Nov;10(11). doi: 10.1161/CIRCIMAGING.116.006007.
BACKGROUND
Multiple echocardiographic methods are used to measure left ventricular size and function. Clinical management is based on individual evaluations and longitudinal trends. The Pediatric Heart Network VVV study (Ventricular Volume Variability) in pediatric patients with dilated cardiomyopathy has reported reproducibility of several of these measures, and how disease state and number of beats impact their reproducibility. In this study, we investigated the impact of observer and sonographer variation on reproducibility of dimension, area, and volume methods to determine the best method for both individual and sequential evaluations.
METHODS AND RESULTS
In 8 centers, echocardiograms were obtained on 169 patients prospectively. During the same visit, 2 different sonographers acquired the same imaging protocol on each patient. Each acquisition was analyzed by 2 different observers; first observer analyzed the first acquisition twice. Intraobserver, interobserver, interacquisition, and interobserver-acquisition (different observers and different acquisition) reproducibility were assessed on measurements of left ventricular end-diastolic dimension, area, and volume. Left ventricular shortening fraction, ejection fraction, mass, and fractional area change were calculated. Percent difference was calculated as (interobservation difference/mean)×100. Interobserver reproducibility for both acquisitions was better for both volume and dimension measurements (≤0.002) compared with area measurements, whereas intraobserver, interacquisition (for both observers), and interobserver-acquisition reproducibilities (for both observer-acquisition sets) were best for volume measurements (≤0.01). Overall, interobserver-acquisition percent differences were significantly higher than interobserver and interacquisition percent differences (<0.001).
CONCLUSIONS
In pediatric patients with dilated cardiomyopathy, compared with dimension and area methods, left ventricular measurements by volume method have the best reproducibility in settings where assessment is not performed by the same personnel.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT00123071.
背景
多种超声心动图方法用于测量左心室大小和功能。临床管理基于个体评估和纵向趋势。小儿扩张型心肌病患者的小儿心脏网络VVV研究（心室容积变异性）报告了其中几种测量方法的可重复性，以及疾病状态和心跳次数如何影响其可重复性。在本研究中，我们调查了观察者和超声检查人员差异对尺寸、面积和容积测量方法可重复性的影响，以确定个体评估和连续评估的最佳方法。
方法和结果
在8个中心，前瞻性地对169例患者进行了超声心动图检查。在同一次就诊期间，2名不同的超声检查人员对每位患者采用相同的成像方案。每次采集由2名不同的观察者进行分析；第一名观察者对第一次采集进行两次分析。对左心室舒张末期尺寸、面积和容积测量评估了观察者内、观察者间、采集间以及观察者 - 采集间（不同观察者和不同采集）的可重复性。计算左心室缩短分数、射血分数、质量和面积变化分数。百分比差异计算为（观察间差异/平均值）×100。与面积测量相比，两次采集的观察者间可重复性对于容积和尺寸测量均更好（≤0.002），而观察者内、采集间（对于两名观察者）以及观察者 - 采集间可重复性（对于两组观察者 - 采集）对于容积测量最佳（≤0.01）。总体而言，观察者 - 采集间百分比差异显著高于观察者间和采集间百分比差异（<0.001）。
结论
在小儿扩张型心肌病患者中，与尺寸和面积方法相比，在非同一人员进行评估的情况下，容积法测量左心室具有最佳的可重复性。
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