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(Circulation. 2001;104:310.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Reliability of Multicenter Pediatric Echocardiographic Measurements of Left Ventricular Structure and Function

The Prospective P²C² HIV Study

Steven E. Lipshultz, MD; Kirk A. Easley, MS; E. John Orav, PhD; Samuel Kaplan, MD; Thomas J. Starc, MD, MPH; J. Timothy Bricker, MD; Wyman W. Lai, MD, MPH; Douglas S. Moodie, MD; George Sopko, MD, MPH; Mark D. Schluchter, PhD; Steven D. Colan, MD; , for the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study Group

From the Division of Pediatric Cardiology (S.E.L.), University of Rochester Medical Center and Children’s Hospital at Strong, and Department of Pediatrics (S.E.L.), University of Rochester School of Medicine and Dentistry, Rochester, NY; the Department of Cardiology (S.E.L., S.D.C.), Children’s Hospital, and Department of Pediatrics, Harvard Medical School (S.E.L., S.D.C.), Boston, Mass; Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Mass (S.E.L.); Department of Biostatistics and Epidemiology (K.A.E., M.D.S.) and Department of Pediatrics, Division of Pediatric Cardiology (D.S.M.), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Medicine, Brigham and Woman’s Hospital, Boston, Mass (E.J.O.); Department of Pediatrics, Division of Pediatric Cardiology, University of California, Los Angeles Medical Center and School of Medicine, Los Angeles (S.K.); Department of Pediatrics, Division of Pediatric Cardiology, Mt Sinai School of Medicine, New York, NY (W.W.L.); Department of Pediatrics, Division of Pediatric Cardiology, Presbyterian Hospital/Columbia University College of Physicians and Surgeons, New York, NY (T.J.S.); Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Tex (J.T.B.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.).

Correspondence to Dr S.E. Lipshultz, Division of Pediatric Cardiology, University of Rochester Medical Center and Children’s Hospital at Strong, 601 Elmwood Ave, Box 631, Rochester, NY 14642. E-mail steve_lipshultz{at}urmc.rochester.edu

Background— To assess the reliability of pediatric echocardiographic measurements, we compared local measurements with those made at a central facility.

Methods and Results— The comparison was based on the first echocardiographic recording obtained on 735 children of HIV-infected mothers at 10 clinical sites focusing on measurements of left ventricular (LV) dimension, wall thicknesses, and fractional shortening. The recordings were measured locally and then remeasured at a central facility. The highest agreement expressed as an intraclass correlation coefficient (ICC=0.97) was noted for LV dimension, with much lower agreement for posterior wall thickness (ICC=0.65), fractional shortening (ICC=0.64), and septal wall thickness (ICC=0.50). The mean dimension was 0.03 cm smaller in central measurements (95% prediction interval [PI], -0.32 to 0.25 cm) for which 95% PI reflects the magnitude of differences between local and central measurements. Mean posterior wall thickness was 0.02 cm larger in central measurements (95% PI, -0.18 to 0.22 cm). Mean fractional shortening was 1% smaller in central measurements. However, the 95% PI was -10% to 8%, indicating that a fractional shortening of 32% measured centrally could be anywhere between 22% and 40% when measured locally. Central measurements of mean septal thickness were 0.1 cm thicker than local ones (95% PI, -0.18 to 0.34 cm). Centrally measured wall thickness was more closely related to mortality and possibly was more valid than local measurements.

Conclusions— Although LV dimension was reliably measured, local measurements of LV wall thickness and fractional shortening differed from central measurements.

Key Words: echocardiography • pediatrics • AIDS

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