Emory University School of Medicine, Atlanta, GA, USA.
Children's Healthcare of Atlanta, Atlanta, GA, USA.
Echocardiography. 2021 Feb;38(2):296-303. doi: 10.1111/echo.14983. Epub 2021 Jan 24.
Retrospective multicenter research using echocardiograms obtained for routine clinical care can be hampered by issues of individual center quality. We sought to evaluate imaging and patient characteristics associated with poorer quality of archived echocardiograms from a cohort of childhood cancer survivors.
A single blinded reviewer at a central core laboratory graded quality of clinical echocardiograms from five centers focusing on images to derive 2D and M-mode fractional shortening (FS), biplane Simpson's ejection fraction (EF), myocardial performance index (MPI), tissue Doppler imaging (TDI)-derived velocities, and global longitudinal strain (GLS).
Of 535 studies analyzed in 102 subjects from 2004 to 2017, all measures of cardiac function could be assessed in only 7%. While FS by 2D or M-mode, MPI, and septal E/E' could be measured in >80% studies, mitral E/E' was less consistent (69%), but better than EF (52%) and GLS (10%). 66% of studies had ≥1 issue, with technical issues (eg, lung artifact, poor endocardial definition) being the most common (33%). Lack of 2- and 3-chamber views was associated with the performing center. Patient age <5 years had a higher chance of apex cutoff in 4-chamber views compared with 16-35 years old. Overall, for any quality issue, earlier era of echo and center were the only significant risk factors.
Assessment of cardiac function using pooled multicenter archived echocardiograms was significantly limited. Efforts to standardize clinical echocardiographic protocols to include apical 2- and 3-chamber views and TDI will improve the ability to quantitate LV function.
利用常规临床护理获得的超声心动图进行回顾性多中心研究可能会受到个别中心质量问题的影响。我们旨在评估来自儿童癌症幸存者队列的存档超声心动图质量较差的影像学和患者特征。
在一个中心核心实验室，一名单盲评审员对五个中心的临床超声心动图质量进行评分，重点是二维和 M 模式分数缩短率（FS）、双平面 Simpson 射血分数（EF）、心肌性能指数（MPI）、组织多普勒成像（TDI）衍生速度和整体纵向应变（GLS）的图像。
在 2004 年至 2017 年间对 102 名患者的 535 项研究进行分析，只有 7%的研究能够评估所有心脏功能指标。虽然二维或 M 模式 FS、MPI 和间隔 E/E'可以在>80%的研究中测量，但二尖瓣 E/E'不太一致（69%），但优于 EF（52%）和 GLS（10%）。66%的研究存在≥1个问题，其中技术问题（例如，肺伪影、心内膜定义不良）最为常见（33%）。缺乏 2 腔和 3 腔视图与进行中心相关。与 16-35 岁相比，年龄<5 岁的患者在 4 腔视图中出现心尖截点的可能性更高。总体而言，对于任何质量问题，早期的超声心动图时代和中心是唯一的显著危险因素。
使用多中心存档超声心动图进行心脏功能评估受到严重限制。努力使临床超声心动图协议标准化，包括心尖 2 腔和 3 腔视图和 TDI，将提高定量 LV 功能的能力。
