A COMPARISON OF TRANSESOPHAGEAL AND TRANSTHORACIC ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT-VENTRICULAR FUNCTION IN PEDIATRIC-PATIENTS WITH CONGENITAL HEART-DISEASE

Objective: To determine the quantitative utility of transesophageal ec hocardiographic assessments of left ventricular function in pediatric patients with congenital heart disease by evaluating the variability b etween observers and between echocardiographic windows. Design: Retros pective, blinded analysis. Setting: University-associated pediatric ho spital. Participants: Transthoracic and transesophageal echocardiograp hic images of 25 pediatric patients with congenital heart disease were reviewed. Interventions: None. Measurements and Main Results: End-dia stolic area, end-systolic area, and fractional area change were measur ed from short-axis images of the left ventricle at the midpapillary le vel by two separate investigators. These measurements were compared by the method of Bland and Altman and Sheiner and Beal. Significant diff erences in measurements of end-diastolic and end-systolic area by diff erent observers were noted, but they were systematic. A similar situat ion was noted for the comparison of transthoracic and transesophageal measurements of end diastolic and end-systolic area. In the comparison of fractional area change between observers or windows, bias and abso lute prediction error were lower, with 95% confidence limits of bias o r absolute prediction error of 10% or less. Conclusions: The potential error in the measurement of fractional area change is 10% under optim al conditions. This would suggest that the assessment of ventricular f unction in the operating room or intensive care unit, under less than optimal conditions, should be viewed as a qualitative, rather quantita tive, measurement. There may be significant interobserver and interwin dow variability. (C) 1995 by W.B. Saunders Company