Background In extremely preterm neonates, left atrium to aortic root ratio (LA:Ao) and fractional shortening (FS) are commonly used to assess left atrial dilation and left ventricle (LV) function in targeted neonatal echocardiography (TNE), respectively. This study aims to compare the interrater reliability of two-dimensional (2D) and motion mode (M-mode) echocardiography for LA:Ao and FS in preterm infants. Methods A retrospective study was conducted on infants born <29 weeks gestational age who underwent TNE between October 2020 and September 2023. Interrater reliability for LA:Ao and FS was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots. Results A total of 79 scans were assessed independently by 3 observers. Median (IQR) gestational age was 25.9 (25–27.3) weeks and birth weight was 797 (627.5–916.8) grams. The ICC for LV FS was 0.72 (95% CI: 0.40–0.85) for M-mode and 0.73 (95% CI: 0.56–0.83) for 2D-mode. The ICC for LA: Ao ratio was 0.87 for both M-mode (95% CI: 0.73–0.93) and 2D-mode (95% CI: 0.80–0.92). Conclusion Both 2D and M-modes are reliable markers for measuring LA:Ao ratio in extremely preterm infants. FS should be interpreted cautiously as a marker of LV systolic function due to moderate reliability. Impact <UnorderedList Mark="Bullet"> <ItemContent> Both two-dimensional (2D) and motion mode (M-mode) showed good interrater reliability for left atrium and aortic root (LA:Ao) ratio measurements. Findings support the interchangeable use of either modality in Targeted Neonatal Echocardiography (TNE) protocols for assessing left atrial dilation. </ItemContent> <ItemContent> Fractional shortening (FS) demonstrated only moderate reliability across both modes, reinforcing the need for caution when using FS alone to evaluate left ventricular function in extremely preterm infants. </ItemContent> <ItemContent> Results highlight the importance of standardized TNE-specific training and routine quality assurance (QA) processes to minimize variability and ensure consistency in clinical and research echocardiographic assessments. </ItemContent> </UnorderedList>

Reliability of two-dimensional versus M-mode echocardiography for left atrium/aortic diameter ratio and fractional shortening in extremely preterm infants

期刊论文
发表日期：

2025年9月18日

查看全文

Uthaya Kumaran Kanagaraj,
Michael Castaldo,
Melissa Braschel,
Anna Harris,
Souvik Mitra

摘要

Background

In extremely preterm neonates, left atrium to aortic root ratio (LA:Ao) and fractional shortening (FS) are commonly used to assess left atrial dilation and left ventricle (LV) function in targeted neonatal echocardiography (TNE), respectively. This study aims to compare the interrater reliability of two-dimensional (2D) and motion mode (M-mode) echocardiography for LA:Ao and FS in preterm infants.

Methods

A retrospective study was conducted on infants born <29 weeks gestational age who underwent TNE between October 2020 and September 2023. Interrater reliability for LA:Ao and FS was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots.

Results

A total of 79 scans were assessed independently by 3 observers. Median (IQR) gestational age was 25.9 (25–27.3) weeks and birth weight was 797 (627.5–916.8) grams. The ICC for LV FS was 0.72 (95% CI: 0.40–0.85) for M-mode and 0.73 (95% CI: 0.56–0.83) for 2D-mode. The ICC for LA: Ao ratio was 0.87 for both M-mode (95% CI: 0.73–0.93) and 2D-mode (95% CI: 0.80–0.92).

Conclusion

Both 2D and M-modes are reliable markers for measuring LA:Ao ratio in extremely preterm infants. FS should be interpreted cautiously as a marker of LV systolic function due to moderate reliability.

Impact

Both two-dimensional (2D) and motion mode (M-mode) showed good interrater reliability for left atrium and aortic root (LA:Ao) ratio measurements. Findings support the interchangeable use of either modality in Targeted Neonatal Echocardiography (TNE) protocols for assessing left atrial dilation.

Fractional shortening (FS) demonstrated only moderate reliability across both modes, reinforcing the need for caution when using FS alone to evaluate left ventricular function in extremely preterm infants.

Results highlight the importance of standardized TNE-specific training and routine quality assurance (QA) processes to minimize variability and ensure consistency in clinical and research echocardiographic assessments.