Low agreement between cardiologists diagnosing left ventricular hypertrophy in children with end-stage renal disease

Abstract

BackgroundMonitoring of the appearance of left ventricular hypertrophy (LVH) by echocardiography is currently recommended for in the management of children with End-stage renal disease (ESRD). In order to investigate the validity of this method in ESRD children, we assessed the intra- and inter-observer reproducibility of the diagnosis LVH.MethodsEchocardiographic measurements in 92 children (0–18 years) with ESRD, made by original analysists, were reassessed offline, twice, by 3 independent observers. Smallest detectable changes (SDC) were calculated for continuous measurements of diastolic interventricular septum (IVSd), Left ventricle posterior wall thickness (LVPWd), Left ventricle end-diastolic diameter (LVEDd), and Left ventricle mass index (LVMI). Cohen’s kappa was calculated to assess the reproducibility of LVH defined in two different ways. LVHWT was defined as Z-value of IVSd and/or LVPWd>2 and LVHMI was defined as LVMI> 103 g/m2 for boys and >84 g/m2 for girls.ResultsThe intra-observer SDCs ranged from 1.6 to 1.7 mm, 2.0 to 2.6 mm and 17.7 to 30.5 g/m2 for IVSd, LVPWd and LVMI, respectively. The inter-observer SDCs were 2.6 mm, 2.9 mm and 24.6 g/m2 for IVSd, LVPWd and LVMI, respectively. Depending on the observer, the prevalence of LVHWT and LVHMI ranged from 2 to 30% and from 8 to 25%, respectively. Kappas ranged from 0.4 to 1.0 and from 0.1 to 0.5, for intra-and inter- observer reproducibility, respectively.ConclusionsChanges in diastolic wall thickness of less than 1.6 mm or LVMI less than 17.7 g/m2 cannot be distinguished from measurement error in individual children, even when measured by the same observer. This limits the use of echocardiography to detect changes in wall thickness in children with ESRD in routine practice.

The FGF23–Klotho axis and cardiac tissue Doppler imaging in pediatric chronic kidney disease—a prospective cohort study

“…The diagnostic methodology could be one potential factor explaining the discrepancy in our findings. Indeed, Schoenmaker et al [ 41 ] show high variations in LVMI analyses between observers, while TDI has been shown to be a sensitive method to assess cardiac dysfunction [ 30 ]. Further, we acknowledge small differences in results where analyses are based on FGF23 z -score or its raw unadjusted data, which could be another reason for differences between studies.…”

Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease

“…In our study, LV mass increased in 21 % of the dialysis patients and 24 % of the renal transplant patients, suggesting some degree of LVH, but the presence of LVH did not seem to be a risk factor for the decrease in LS, in turn suggesting that the changes in strain can be present in ESRD patients in the absence of LVH. However, it should be noted that the measurement of LVH in pediatric ESRD has already been shown to be less reliable, as demonstrated by Schoenmaker et al [ 38 ].…”

Diastolic dysfunction measured by tissue Doppler imaging in children with end-stage renal disease: a report of the RICH-Q study

“…However, reports on the reproducibility and validity of this assessment in children are scarce. In an earlier study of the same cohort, we found conventional echocardiography to be insufficiently sensitive and accurate for a reliable diagnosis of left ventricular hypertrophy 4 . Tissue Doppler imaging appears to be a promising method for the detection and quantification of subtle abnormalities in diastolic ventricle function in adults 5 .…”

“…In an earlier study of the same cohort, we found conventional echocardiography to be insufficiently sensitive and accurate for a reliable diagnosis of left ventricular hypertrophy. 4 Tissue Doppler imaging appears to be a promising method for the detection and quantification of subtle abnormalities in diastolic ventricle function in adults. 5 In order to investigate whether this method would also be useful in children with end-stage renal disease, we compared the accuracy of two echocardiographic techniques, that is, conventional echocardiography and tissue Doppler imaging, to detect impairment of left ventricular diastolic function.…”