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Right ventricular systolic function in hypoplastic left heart syndrome: A comparison of manual and automated software to measure fractional area change
Author(s) -
Ruotsalainen Hanna K.,
BellshamRevell Hannah R.,
Bell Aaron J.,
Pihkala Jaana I.,
Ojala Tiina H.,
Simpson John M.
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13470
Subject(s) - hypoplastic left heart syndrome , repeatability , medicine , ejection fraction , ventricular function , magnetic resonance imaging , nuclear medicine , correlation coefficient , norwood procedure , cardiology , heart disease , radiology , mathematics , heart failure , statistics
Background Quantitative echocardiographic assessment of right ventricular function is important in children with hypoplastic left heart syndrome (HLHS). The aim of this study was to examine the repeatability of different echocardiographic techniques, both manual and automated, to measure fractional area change (FAC) in patients with HLHS and to correlate these measurements with magnetic resonance imaging (MRI)‐derived ejection fraction (EF). Methods Fifty‐one children with HLHS underwent transthoracic echocardiography and cardiac MRI under the same general anesthetic as part of routine inter‐stage assessment. FAC was measured from the apical four‐chamber view using three different techniques: velocity vector imaging (VVI) (Syngo USWP 3.0; Siemens Healthineers), QLAB (Q‐lab R 10.0; Philips Healthcare), and manual endocardial contour tracing (Xcelera, Philips Healthcare). Intra‐ and inter‐observer variability was calculated using intra‐class correlation coefficient (ICC). FAC was correlated with MRI EF calculated using a single standard method. Results Fractional area change had a good correlation with MRI‐derived EF with an R value for VVI, QLAB, and manual methods of .7, .6, and .4, respectively. Intra‐ and inter‐observer variability for FAC was good for automated echocardiographic methods (ICC>.85) but worse for manual method particularly inter‐observer variability of FAC and end‐systolic area. Both automated techniques tended to produce higher FAC values compared with manual measurements ( P <.001). Conclusion Automation improves the repeatability of FAC in HLHS. There are some differences between automated software in terms of correlation with MRI‐derived EF. Measurement bias and wide limits of agreement mean that the same echocardiographic technique should be used during the follow‐up of individual patients.