Subjective Evaluation of Right Ventricular Systolic Function in Hypoplastic Left Heart Syndrome: How Accurate Is It?

TY - JOUR

T1 - Subjective Evaluation of Right Ventricular Systolic Function in Hypoplastic Left Heart Syndrome

T2 - How Accurate Is It?

AU - Bellsham-Revell, Hannah R.

AU - Simpson, John M.

AU - Miller, Owen

AU - Bell, Aaron

PY - 2013/1

Y1 - 2013/1

N2 - Background: The geometry and heterogeneity of the right ventricle in hypoplastic left heart syndrome makes objective echocardiographic assessment of systolic function challenging. Consequently, subjective echocardiographic assessment of right ventricular (RV) function is still routinely undertaken. The aims of this study were to compare this with magnetic resonance imaging (MRI), investigate the impact of experience and training on the accuracy of subjective assessment, and critically analyze the role of echocardiography to detect impaired systolic function. Methods: A retrospective analysis of prospectively acquired data was performed. Children with hypoplastic left heart syndrome underwent routine preoperative cardiac MRI and echocardiography under the same general anesthetic. Echocardiograms were reviewed, and members of the congenital heart disease team with differing echocardiography experience subjectively graded RV systolic function (good, moderate, or poor). This was compared with MRI-derived ejection fraction. Results: Twenty-eight patients at different palliative stages were included. Twenty-eight observers were divided into five experience categories (congenital heart disease junior trainees to attending cardiologists). Median agreement was 47.6% (range, 31.4%-58.2%), with the lowest agreement among junior trainees and the highest among attending cardiologists. When used as a screening test for poor RV systolic function, the median sensitivity of echocardiography was 0.89 (range, 0.86-0.96), and median specificity was 0.45 (range, 0.26-0.55). The highest sensitivity was observed among junior trainees but with the lowest specificity. The highest specificity was observed among attending cardiologists (0.55). Conclusions: Agreement between echocardiographic and MRI RV ejection fraction improves with experience but remains suboptimal. When used as a screening test for poor RV function, echocardiography is sensitive, but specificity is heavily influenced by operator experience.

AB - Background: The geometry and heterogeneity of the right ventricle in hypoplastic left heart syndrome makes objective echocardiographic assessment of systolic function challenging. Consequently, subjective echocardiographic assessment of right ventricular (RV) function is still routinely undertaken. The aims of this study were to compare this with magnetic resonance imaging (MRI), investigate the impact of experience and training on the accuracy of subjective assessment, and critically analyze the role of echocardiography to detect impaired systolic function. Methods: A retrospective analysis of prospectively acquired data was performed. Children with hypoplastic left heart syndrome underwent routine preoperative cardiac MRI and echocardiography under the same general anesthetic. Echocardiograms were reviewed, and members of the congenital heart disease team with differing echocardiography experience subjectively graded RV systolic function (good, moderate, or poor). This was compared with MRI-derived ejection fraction. Results: Twenty-eight patients at different palliative stages were included. Twenty-eight observers were divided into five experience categories (congenital heart disease junior trainees to attending cardiologists). Median agreement was 47.6% (range, 31.4%-58.2%), with the lowest agreement among junior trainees and the highest among attending cardiologists. When used as a screening test for poor RV systolic function, the median sensitivity of echocardiography was 0.89 (range, 0.86-0.96), and median specificity was 0.45 (range, 0.26-0.55). The highest sensitivity was observed among junior trainees but with the lowest specificity. The highest specificity was observed among attending cardiologists (0.55). Conclusions: Agreement between echocardiographic and MRI RV ejection fraction improves with experience but remains suboptimal. When used as a screening test for poor RV function, echocardiography is sensitive, but specificity is heavily influenced by operator experience.

KW - Magnetic resonance imaging

KW - Echocardiography

KW - Experience

KW - Hypoplastic left heart syndrome

KW - MYOCARDIAL PERFORMANCE INDEX

KW - ECHOCARDIOGRAPHIC-ASSESSMENT

KW - NORWOOD OPERATION

KW - SINGLE VENTRICLES

KW - FONTAN SURGERY

KW - CHILDREN

KW - RECOMMENDATIONS

KW - QUANTIFICATION

KW - DEFORMATION

KW - SUBTYPES

U2 - 10.1016/j.echo.2012.09.020

DO - 10.1016/j.echo.2012.09.020

M3 - Article

SN - 0894-7317

VL - 26

SP - 52

EP - 56

JO - Journal of The American Society of Echocardiography

JF - Journal of The American Society of Echocardiography

IS - 1

ER -