Comparison of visual estimation of ventricular systolic function with quantitative echocardiographic markers in newborn infants

Q: What are the key findings of this study?

Visual estimation of neonatal ventricular systolic function showed limited concordance with quantitative markers overall (sensitivity 25-80%, specificity 38-78%), though sensitivity reached 100% for severe LV dysfunction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ventricular systolic dysfunction assessment in newborn infants (n=60). Intervention: Visual estimation of biventricular systolic function by NPE and non-NPE operators vs. Quantitative echocardiographic markers (shortening fraction, Simpson's biplane ejection fraction, global longitudinal strain, TAPSE, and fractional area change). Primary outcome: Concordance (Cohen's Kappa) and diagnostic accuracy (sensitivity and specificity) between visual estimation and quantitative echocardiographic markers for biventricular systolic function.

Q: What does this research mean for the field?

Visual estimation of ventricular systolic function in newborn infants exhibits limited overall concordance with quantitative echocardiographic markers, although sensitivity increases to 100% for detecting severe left ventricular dysfunction. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sujith S. Pereira; Beena Yeldo; Rachael Fleming; Saulius Šatas

doi:10.1186/s44156-026-00142-2

October 26, 2026Echo Research and PracticeOpen Access

Comparison of visual estimation of ventricular systolic function with quantitative echocardiographic markers in newborn infants

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Key result

Visual estimation of neonatal ventricular function shows limited quantitative concordance except in severe LV dysfunction.

n=60

Why the study?

Neonatologist-performed echocardiography (NPE) operators typically visually estimate systolic function and confirm it with quantitative markers when indicated, making it necessary to evaluate the concordance between qualitative and quantitative echocardiographic markers among NPE and non-NPE operators.

Does qualitative visual estimation of biventricular systolic function correlate with quantitative echocardiographic markers when assessed by NPE and non-NPE operators in newborn infants?

Key Points

To assess concordance between visual estimation of biventricular systolic function and standard quantitative echocardiographic markers among neonatologist-performed echocardiography (NPE) and non-NPE operators.
Prospective cohort study of N=60 newborn infants undergoing routine echocardiography at Homerton University Hospital and Aberdeen Maternity Hospital between April 2024 and October 2024.
Blinded NPE and non-NPE operators independently assessed left and right ventricular systolic function visually and compared results against quantitative markers (shortening fraction, Simpson's ejection fraction, global longitudinal strain, TAPSE, and fractional area change).
Across all echocardiographic parameters, sensitivity for visual estimation ranged from 25% to 80% and specificity ranged from 38% to 78%.
For left ventricular dysfunction defined by shortening fraction, visual estimation sensitivity increased with worsening severity from 20% for mild dysfunction to 100% for severe dysfunction.
Inter-operator concordance was generally limited, but test-retest reliability was acceptable for Simpson's ejection fraction (ICC 0.61, p=0.016), global longitudinal strain (ICC 0.64, p=0.021), and right ventricular fractional area change (ICC 0.83, p=0.002).

Study Design

Type

Cohort (n=60)

Blinding

Blinded

Multicenter

Yes

Structured PICO

Does qualitative visual estimation of biventricular systolic function correlate with quantitative echocardiographic markers when assessed by NPE and non-NPE operators in newborn infants?

P

Population

60 newborn infants (mean gestation 34 weeks, mean birth weight 2311 g) undergoing routine neonatologist-performed echocardiography at two UK tertiary neonatal centers over a 6-month period.

E

Exposure

Qualitative visual estimation of left and right ventricular systolic function (classified as normal or impaired) using apical 4-chamber and parasternal views by blinded NPE and non-NPE operators

C

Comparator

Standard quantitative echocardiographic markers derived by NPE operators: LV shortening fraction (SF <26%), Simpson's biplane ejection fraction (EF <50%), LV global longitudinal strain (GLS > -20%), RV tricuspid annular plane systolic excursion (TAPSE <2 SD), and RV fractional area change (FAC <2 SD)

O

Outcome

Concordance between qualitative visual estimation and quantitative echocardiographic markers for biventricular systolic function assessed using Cohen's Kappa coefficientsurrogate

Visual estimation on neonatal echocardiography can rapidly identify severe ventricular dysfunction at the bedside, but objective quantitative parameters are necessary to reliably detect mild-to-moderate dysfunction.

Limitations

Small sample size with convenience sampling and low prevalence of significant cardiac dysfunction.
Heterogeneous cohorts between the two centers regarding prematurity, respiratory support, and inotrope use.
Did not account for the hemodynamic significance of patent ductus arteriosus or transitional circulation loading conditions.
Binary classification of LV systolic function (normal vs impaired) rather than stratification by severity across all analyses.
Test-retest reliability analysis was only available for a single NPE operator at one site.
Exploratory study with convenience sampling and low prevalence of ventricular dysfunction
Heterogeneous cohorts between the two centers (Centre 1 had lower gestational age, lower birth weight, and higher mechanical ventilation use)
Did not account for hemodynamic significance of patent ductus arteriosus or altered loading conditions in transitional circulation
Binary classification of ventricular function (normal vs impaired) rather than multi-grade severity stratification
Test-retest reliability was performed by only one NPE operator at a single site

Implication

Visual estimation may aid rapid bedside detection of severe neonatal LV dysfunction; leaves open reliability for milder cases and requires prospective validation.

Abstract

Background Neonatologist-performed echocardiography (NPE) is increasingly practiced. NPE operators typically use visual estimation of systolic function and, if indicated, confirm function using quantitative echocardiographic markers. This exploratory study aims to compare the concordance between qualitative and quantitative echocardiographic markers among NPE and non-NPE operators. Methods We studied a cohort of newborn infants, undergoing routine NPE by the authors at Homerton University Hospital and Aberdeen Maternity Hospital from April 2024 to October 2024. Blinded NPE and non-NPE operators independently assessed left and right ventricular systolic function visually. We compared visual estimation with standard quantitative echocardiographic markers such as shortening fraction, Simpson’s ejection fraction and global longitudinal strain for left ventricle and tricuspid annular plane systolic excursion and fractional area change for right ventricle. We examined the concordance between visual estimation and quantitative echocardiographic markers for biventricular systolic function. Results Sixty infants with a mean (SD) gestation and birth weight of 34 (6.2) weeks and 2311 (1319) grams respectively were examined. Sensitivity testing for all echocardiographic parameters ranged from 25% to 80% whereas specificity ranged from 38% to 78%. Sensitivity increased with worsening grades of LV dysfunction defined using shortening fraction. While concordance between NPE and non-NPE operator was generally limited across most echocardiographic parameters, test-retest reliability was acceptable for several quantitative measures, including Simpson’s ejection fraction, global longitudinal strain and right ventricular fractional area change. Conclusion Visual estimation may be a useful bedside tool for detecting severe ventricular dysfunction in newborn infants; however; quantitative echocardiographic measures are likely to improve the assessment of mild to moderate dysfunction. Further studies should confirm these findings in a larger cohort with a higher representation of infants with ventricular dysfunction.

Discussion

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Cite This Study

Pereira et al. (2026) conducted a cohort in Ventricular systolic dysfunction assessment in newborn infants (n=60). Visual estimation of biventricular systolic function by NPE and non-NPE operators vs. Quantitative echocardiographic markers (shortening fraction, Simpson's biplane ejection fraction, global longitudinal strain, TAPSE, and fractional area change) was evaluated on Concordance (Cohen's Kappa) and diagnostic accuracy (sensitivity and specificity) between visual estimation and quantitative echocardiographic markers for biventricular systolic function. Visual estimation of neonatal ventricular systolic function showed limited concordance with quantitative markers overall (sensitivity 25-80%, specificity 38-78%), though sensitivity reached 100% for severe LV dysfunction.

synapsesocial.com/papers/6adf55b8953ea0d7a3d1d950 https://doi.org/10.1186/s44156-026-00142-2

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Comparison of visual estimation of ventricular systolic function with quantitative echocardiographic markers in newborn infants

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Comparison of visual estimation of ventricular systolic function with quantitative echocardiographic markers in newborn infants

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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