Repeatability of echocardiographic parameters to evaluate the hemodynamic relevance of patent ductus arteriosus in preterm infants: a prospective observational study

Abstract

BackgroundThe hemodynamically relevant patent ductus arteriosus in preterm infants is not well defined. Different clinical and echocardiographic parameters are used and the diagnostic accuracy is unknown because of the lack of a gold standard definition. Our study evaluates the inter-observer repeatability of echocardiographic and Doppler-ultrasound parameters.MethodsThis prospective observational study included 19 very low birth weight preterm infants (median [interquartile range]: gestational age 28.0 (28.0–29.0) weeks, birth weight 1130 (905–1321) g, postnatal age at measurement 8.7 (4.8–23.5) d) with a clinical suspicion of ductal patency in whom 27 repeated echocardiographic and Doppler-ultrasound examinations were performed within 30 min by 2 of 3 independent observers (54 measurements overall). The repeatability index (=2 times the standard deviation of the differences/mean of all measurements) according to Bland and Altman was used to assess repeatability of different parameters.ResultsThe repeatability indices of the echocardiographic parameters (left Atrium-to-Aortic root-ratio, diameter of the patent ductus arteriosus at its narrowest part, the left-ventricular-preejection-period-to-ejection-time-ratio and the ratio of the velocity time integrals in the large vessels were 16, 21, 23 and 26 % respectively. The repeatability indices of Doppler-ultrasound measurements (resistance index in celiac artery and anterior cerebral artery) were 11 and 14 %, respectively.ConclusionsThe inter-observer repeatability of all echocardiographic parameters was poor compared to that of resistance indices in peripheral vessels. Therefore, interventions for ductal patency should be indicated based on averaged repeated rather than single measurements, especially when measured values are close to their cut-off value - both in clinical routine and for study purposes.

Development of a Diagnostic Clinical Score for Hemodynamically Significant Patent Ductus Arteriosus

“…Echocardiographic criteria indicating hsPDA were ductus arteriosus diameter at its narrowest part >1.5 mm ( 17 , 18 ) and at least one additional criteria such as absent (end-)diastolic flow in the celiac trunk ( 19 , 20 ), maximal velocity of the left-to-right shunt through the PDA < 1.5 m/s ( 20 , 21 ), left atrial-to-aortic root ratio >1.3 ( 19 , 22 – 27 ).…”

Reliability of Echocardiographic Measurements in Infants Exposed to Zika Virus.

“…Schwarz et al (2016) studied the reliability of echocardiographic parameters for the diagnosis of PDA in low birth weight premature infants and found bad reliability for the size of aortic root and left atrium, while the reliability was somewhat better for other parameters (short axis of the ductus arteriosus, resistance index of the celiac artery and anterior cerebral artery, among others)but some of these parameters were not assessed in our study. [17] Alterations in the Bland-Altmann plot may occur due to the limited number of unique observations and the concentration of points at given mean values, which can lead to low overall agreement indices (e.g., ICC). ICC also considers normal data and is affected by the data's deviation from normality and variability, as is the Bland-Altman plot.…”

Terlipressin‐induced modifications of Doppler ultrasound signals of systemic arteries in preterm infants with vasoactive‐resistant patent ductus arteriosus: A pilot study

“…18,19 Doppler ultrasonography of systemic arteries is a simple, rapid, non-invasive, and repeatable method, which has been reported to successfully assess end-organ perfusion and be useful to adjust therapeutic modalities in the critically ill patients at the bedside. 20 It may enhance our ability to understand the systemic impact of the ductal steal 10,12,17 and allow to objectively direct vasoactive therapy. 11,21 Based on our experience, abnormal Doppler blood flow signals may persist in the systemic arteries of premature infants with hs-PDA, mostly in the renal artery, despite high-dose vasoactive support.…”