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Comparative Study
. 2009 Aug 1;104(3):419-28.
doi: 10.1016/j.amjcard.2009.03.058. Epub 2009 Jun 6.

Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study)

Renee Margossian  1 , Marcy L Schwartz, Ashwin Prakash, Lisa Wruck, Steven D Colan, Andrew M Atz, Timothy J Bradley, Mark A Fogel, Lynne M Hurwitz, Edward Marcus, Andrew J Powell, Beth F Printz, Michael D Puchalski, Jack Rychik, Girish Shirali, Richard Williams, Shi-Joon Yoo, Tal Geva; Pediatric Heart Network Investigators
Collaborators, Affiliations
Comparative Study

Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study)

Renee Margossian et al. Am J Cardiol. .

Abstract

Assessment of the size and function of a functional single ventricle (FSV) is a key element in the management of patients after the Fontan procedure. Measurement variability of ventricular mass, volume, and ejection fraction (EF) among observers by echocardiography and cardiac magnetic resonance imaging (CMR) and their reproducibility among readers in these patients have not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9 +/- 3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Interobserver agreement for qualitative grading of ventricular function by echocardiography was modest for left ventricular (LV) morphology (kappa = 0.42) and weak for right ventricular (RV) morphology (kappa = 0.12). For quantitative assessment, high intraclass correlation coefficients were found for echocardiographic interobserver agreement (LV 0.87 to 0.92, RV 0.82 to 0.85) of systolic and diastolic volumes, respectively. In contrast, intraclass correlation coefficients for LV and RV mass were moderate (LV 0.78, RV 0.72). The corresponding intraclass correlation coefficients by CMR were high (LV 0.96, RV 0.85). Volumes by echocardiography averaged 70% of CMR values. Interobserver reproducibility for the EF was similar for the 2 modalities. Although the absolute mean difference between modalities for the EF was small (<2%), 95% limits of agreement were wide. In conclusion, agreement between observers of qualitative FSV function by echocardiography is modest. Measurements of FSV volume by 2-dimensional echocardiography underestimate CMR measurements, but their reproducibility is high. Echocardiographic and CMR measurements of FSV EF demonstrate similar interobserver reproducibility, whereas measurements of FSV mass and LV diastolic volume are more reproducible by CMR.

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Conflict of interest statement

The authors state no conflicts of interest exist.

Figures

Figure 1
Figure 1. Intra-rater comparison of echocardiographic measures
Solid line indicates perfect agreement, dashed line indicates mean difference; dotted lines indicate 95% limits of agreement. LV: left ventricle; RV: right ventricle.
Figure 2
Figure 2. Inter-rater comparison of echocardiographic measures
Solid line indicates perfect agreement, dashed line indicates mean difference; dotted lines indicate 95% limits of agreement. LV: left ventricle; RV: right ventricle.
Figure 3
Figure 3. Inter-rater comparison of CMR measures
Solid line indicates perfect agreement, dashed line indicates mean difference; dotted lines indicate 95% limits of agreement. LV: left ventricle; RV: right ventricle.
Figure 4
Figure 4. Comparison of Echocardiographic and CMR derived values for EDV, ESV, and ventricular mass
Solid line indicates perfect agreement, dashed line indicates geometric mean of the ratio; dotted lines indicate 95% limits of agreement. Ratios are plotted on a log scale. CMR: cardiac magnetic resonance; EDV: end-diastolic volume; ESV: end-systolic volume; g: grams; ml: milliliters; LV: left ventricle; RV: right ventricle.
Figure 5
Figure 5. Comparison of Echocardiographic and CMR derived LV and RV ejection fraction
A. Bar graphs demonstrating the frequency of differences between Echo and CMR measures of EF. B. Echo/CMR comparison for EF. Solid line indicates perfect agreement, dashed line indicates mean difference, dotted lines indicate 95% limits of agreement. CMR: cardiac magnetic resonance; LV: left ventricle; RV: right ventricle.
See this image and copyright information in PMC

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