Analysis of the Pediatric Heart Network Echocardiogram Database to Establish Left Ventricular Strain Z-scores

分析儿科心脏网络超声心动图数据库以建立左心室应变 Z 评分

• 批准号: 10515976
• 负责人: L. LuAnn Minich
• 金额: $ 11.44万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-08 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10515976
• 关键词: 18 year old; Address; Adult; Age; Area; Autoimmune Diseases; Birth; Body Size; Body Surface Area; Body mass index; Cardiac; Cardiovascular system; Categories; Child; Childhood; Clinical; Computer software; Data Set; Databases; Dependence; Dimensions; Disease; Disease Management; EFRAC; Echocardiography; Endocrine System Diseases; Evaluation; Frequencies; Gender; Goals; Growth; Heart; Heart Diseases; Heart Rate; Heart failure; Height; Hematological Disease; Image; Lead; Left; Left Ventricular Dysfunction; Left Ventricular Function; Length; Longitudinal Studies; Lung diseases; Measurement; Measures; Methods; Movement; Myocardial; North America; Participant; Pathology; Pediatric cardiology; Population; Population Heterogeneity; Process; Prognosis; Protocols documentation; Race; Reference Values; Reproducibility; Research; Research Personnel; Residual state; Resolution; Risk; Sampling; Sepsis; Shortening Fraction; Sleep Disorders; Standardization; Technology; Thick; Trauma; Variant; Ventricular; Weight; age effect; age related; base; cancer therapy; clinical care; clinical practice; cohort; cost effective; detector; digital imaging; flexibility; heart function; improved; indexing; outcome prediction; predict clinical outcome; prospective; secondary analysis; sex; standard of care; tool

PROJECT SUMMARY In children, calculating ejection (EF) and shortening fraction (SF) using echocardiography (echo) is the standard of care for evaluating left ventricular (LV) function. Despite their ubiquitous use, EF and SF are poorly reproducible, calculated from multiple measurements each with their own error that is propagated, and measure endocardial volume change without directly measuring contractility. Deformation strain is fundamentally different from EF and SF. Instead of measuring volumes, echo software technology provides speckle-tracking of myocardial movement to measure regional and global myocardial deformation to obtain LV strain. Since this process is automated, it removes a large degree of observer-dependence. In addition, since strain is a single measurement rather than a derived parameter calculated from multiple measurements, the error for machine-derived strain should be substantially reduced. LV strain has been widely studied in adults where normal reference ranges are validated and it is used to predict clinical outcomes and refine therapies. In contrast, LV strain reference values based on a large, diverse population of children are not available and strain remains largely a research tool in the pediatric population. To address this, we will establish Z-scores using the PHN Echo Database. This database includes all images needed for LV strain measurements from 3526 echoes obtained in a well-characterized population of healthy children ranging in age from birth to 18 years. Z-scores account for the effects of maturation and growth by considering body size, age, gender, and/or race when evaluating whether measurements are normal or, if abnormal, how many standard deviations they deviate from the mean. Establishing Z-scores is the most powerful and flexible approach to normalizing cardiovascular parameters for the effects of age and body size and has become the standard approach in pediatric cardiology. We will determine if independent parameters such as age, height, weight, body surface area, or heart rate can predict changes in LV strain with maturation and/or growth. To guide clinical use, we will determine the feasibility and reproducibility of LV strain measurements for images collected as part of routine clinical care rather than as part of a rigorous research protocol. We will evaluate the effect of sampling frequency on Z-scores for clinically indicated studies by comparing those with ≥30 vs. <30 frames/heartbeat in each age category. This project is highly significant and will impact nearly every pediatric subspecialty. LV strain Z-scores will enable longitudinal studies to determine if LV strain is more predictive of outcomes than EF or SF in children. If so, strain would move into clinical use and lead to a paradigm shift in the evaluation and management of diseases where the child is at risk for LV dysfunction and subsequent heart failure. The PHN database of normal echo images obtained as routine clinical care from a large, well-characterized population of healthy children provides a unique, cost-effective opportunity to establish normal LV strain Z-scores and rapidly deploy them for use in the real world setting of a busy pediatric echo lab.

项目摘要 在儿童中，使用超声心动图（echo）计算射血分数（EF）和短轴缩短分数（SF）是 评价左心室（LV）功能的标准治疗。尽管EF和SF的使用无处不在，但它们的性能却很差。 可再现，从多个测量值计算，每个测量值都有自己的传播误差，以及 测量内皮细胞体积变化而不直接测量收缩性。变形应变为 与EF和SF有本质的不同。代替测量体积，回声软件技术提供 心肌运动的斑点跟踪，以测量局部和全局心肌变形，从而获得LV 株由于这个过程是自动化的，它消除了很大程度上的依赖。另外由于 应变是一个单一的测量，而不是从多个测量计算得出的参数， 机器导出的应变的误差应该大大减小。LV毒株已在成人中进行了广泛研究 其中正常参考范围得到验证，并用于预测临床结果和改进治疗。在 相反，基于大量不同儿童人群的LV应变参考值不可用， 菌株仍然主要是儿科人群的研究工具。为了解决这个问题，我们将建立Z分数 使用PHN Echo数据库该数据库包括LV应变测量所需的所有图像， 在年龄从出生到18岁的健康儿童的良好特征人群中获得3526个回波 年Z分数通过考虑体型、年龄、性别和/或性别来说明成熟和生长的影响。 在评估测量值是否正常时，或者如果不正常， 偏离平均值。建立Z分数是规范化的最强大、最灵活的方法 心血管参数的年龄和身体大小的影响，并已成为标准的方法， 儿科心脏病学我们将确定独立参数，如年龄，身高，体重，体表面积 面积或心率可以预测LV应变随成熟和/或生长的变化。为了指导临床使用，我们将 确定LV应变测量的可行性和可重复性，用于常规采集的图像 临床护理，而不是作为严格的研究方案的一部分。我们将评估抽样的效果 通过比较≥ 30帧/心跳与<30帧/心跳的频率， 每个年龄段。该项目意义重大，将影响几乎所有儿科专科。LV 应变Z评分将使纵向研究能够确定LV应变是否比EF更能预测结局 SF在儿童如果是这样的话，菌株将进入临床使用，并导致评估的范式转变， 管理儿童有LV功能障碍和随后的心力衰竭风险的疾病。PHN 作为常规临床护理，从一个大型的、特征良好的人群中获得的正常回波图像数据库， 健康的儿童提供了一个独特的，具有成本效益的机会，建立正常的LV应变Z评分，并迅速 部署它们以在忙碌的儿科回声实验室的真实的世界环境中使用。