Because comprehensive normal data and the effect of observer variability for echocardiography evaluation of regional left ventricular wall motion are not available in children or newborns, left ventricular wall motion was assessed by measuring regional area change. The study group comprised 55 infants and children with a normal heart: 15 neonates (>1 week to <1 month old), 10 infants (>1 month to <1 year old) and 30 children, 10 each in the age group >1 year to <5 years, >5 to ≤10 years and >10 years. A combination of parasternal, apical and subcostal two-dimensional echocardiographic views was applied. After planimetry of an end-systolic and end-diastolic frame, the left ventricle was divided into eight equal segments and the percent area change calculated. Both a fixed reference and a floating system correcting for translation and rotation were applied.
Intraobserver variability for percent area change measurements was 2.8 ± 0.9% and 3.8 ±1% for observers 1 and 2, respectively. The mean interobserver difference of regional percent area change was 4.7 ± 1.8%. Normal values for the eight anatomic segments were established in each echocardiographic imaging plane. The overall results were independent of the type of reference system utilized. The subcostal views yielded different results from their parasternal counterparts, probably because of differing imaging planes. These normal values establish a data base in the pediatric age range that can be used to detect abnormal segments in children at risk for developing regional left ventricular wall motion abnormalities.
From the Division of Cardiology, Department of Pediatrics, University of Toronto, Faculty of Medicine and The Hospital for Sick Children. Toronto, Ontario, Canada.
Dr. Vogel was supported by Grant Vo 390/1 from the Deutsche Forschungsgemeinschaft, Bonn, Federal Republic of Germany. His current address is: Department of Pediatrics, Deutsche Herzzentrum Lothstr 11, D-8000 Munich, Federal Republic of Germany.
