Szugye Nicholas A, Shuler Jeffrey M, Pradhan Sarah, Plasencia Jonathan D, Villa Chet, Taylor Michael, Lorts Angela, Zafar Farhan, Morales David L S, Moore Ryan A
Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Am Soc Echocardiogr. 2023 Feb;36(2):224-232. doi: 10.1016/j.echo.2022.08.014. Epub 2022 Sep 8.
Donor-to-recipient size matching for heart transplantation typically involves comparing donor and recipient body weight; however, weight is not linearly related to cardiac size. Attention has shifted toward the use of computed tomography- (CT-) derived total cardiac volume (TCV), that is, CT-TCV, to compare donor and recipient heart organ size. At this time, TCV size matching is near impossible for most centers due to logistical limitations. To overcome this impediment, echocardiogram-derived TCV (ECHO-TCV) is an attractive, alternative option to estimate CT-TCV. The goal of this study is to test whether ECHO-TCV is an accurate and reliable surrogate for TCV measurement compared with the gold standard CT-TCV.
ECHO-TCV and CT-TCV were measured in a cohort spanning the neonatal to young adult age range with the intention to simulate the pediatric heart transplant donor pool. ECHO-TCV was measured using a modified Simpson's summation-of-discs method from the apical 4-chamber (A4C) view. The gold standard of CT-TCV was measured from CT scans using three-dimensional reconstruction software. The relationship between ECHO-TCV and CT-TCV was evaluated and compared with other anthropometric and image-based markers that may predict CT-TCV. Inter-rater reliability of ECHO-TCV was tested among 4 independent observers. Subanalyses were performed to identify imaging views and timing that enable greater accuracy of ECHO-TCV.
Banked imaging data of 136 subjects with both echocardiogram and CT were identified. ECHO-TCV demonstrated a linear relationship to CT-TCV with a Pearson correlation coefficient of r = 0.96 (95% CI, 0.95-0.97; P < .0001) and mean absolute percent error of 8.6%. ECHO-TCV correlated most strongly with CT-TCV in the subset of subjects <4 years of age (n = 33; r = 0.98; 95% CI, 0.96-0.99; P < .0001). The single-score intraclass correlation coefficient across all 4 raters is 0.96 (interquartile range, 0.93-0.98). ECHO-TCV measured from a standard A4C view at end diastole with the atria in the plane of view had the strongest correlation to CT-TCV.
ECHO-TCV by the A4C view was found to be both an accurate and reliable alternative measurement of CT-TCV and is derived from readily available donor ECHO images. The ECHO-TCV findings in this study make the ECHO method an attractive means of direct donor-to-recipient TCV size matching in pediatric heart transplantation.
心脏移植中供体与受体的大小匹配通常涉及比较供体和受体的体重；然而，体重与心脏大小并非线性相关。人们的注意力已转向使用计算机断层扫描（CT）得出的全心容积（TCV），即CT-TCV，来比较供体和受体的心脏器官大小。目前，由于后勤方面的限制，对于大多数中心而言，TCV大小匹配几乎是不可能的。为克服这一障碍，超声心动图得出的TCV（ECHO-TCV）是估计CT-TCV的一种有吸引力的替代选择。本研究的目的是测试与金标准CT-TCV相比，ECHO-TCV是否是TCV测量的准确且可靠的替代指标。
在一个涵盖新生儿至青年成人年龄范围的队列中测量ECHO-TCV和CT-TCV，旨在模拟小儿心脏移植供体库。使用改良的辛普森圆盘求和法从心尖四腔心（A4C）视图测量ECHO-TCV。CT-TCV的金标准通过使用三维重建软件从CT扫描中测量得出。评估ECHO-TCV与CT-TCV之间的关系，并与其他可能预测CT-TCV的人体测量和基于图像的指标进行比较。在4名独立观察者之间测试ECHO-TCV的评分者间信度。进行亚组分析以确定能提高ECHO-TCV准确性的成像视图和时机。
确定了136名同时有超声心动图和CT检查的受试者的存档影像数据。ECHO-TCV与CT-TCV呈线性关系，皮尔逊相关系数r = 0.96（95%CI，0.95 - 0.97；P <.0001），平均绝对百分比误差为8.6%。在年龄<4岁的受试者亚组中（n = 33；r = 0.98；95%CI，0.96 - 0.99；P <.0001），ECHO-TCV与CT-TCV的相关性最强。所有4名评分者的单评分组内相关系数为0.96（四分位间距，0.93 - 0.98）。在舒张末期从标准AHC视图测量的ECHO-TCV，且心房在视图平面内时，与CT-TCV的相关性最强。
通过A4C视图得出的ECHO-TCV被发现是CT-TCV的准确且可靠的替代测量方法，并且它源自现成的供体超声心动图图像。本研究中ECHO-TCV的结果使超声心动图方法成为小儿心脏移植中供体与受体TCV大小直接匹配的一种有吸引力的手段。
