By David K. Werho, MD (@DWerho) – Associate Editor, Social Media

Cardiology in the Young  (@CardiologyYoung)

In their recently published article in Cardiology in the Young, titled “Challenges and lessons learned from the Pediatric Heart Network Normal Echocardiogram Database study,” (Truong, Dongngan, et al. (Cardiology in the Young (2020): 1-6), Dr. Truong and her colleagues discussed the various aspects arising in the course of their study that were unexpected, including several obstacles to the completion of the study.  Despite the many challenges they faced, they were able to create the first large, multi-institutional standardized, pediatric z-score database that accounts for age, race, and gender (Lopez, Leo, et al. “Relationship of echocardiographic Z scores adjusted for body surface area to age, sex, race, and ethnicity: the Pediatric Heart Network Normal Echocardiogram Database.” Circulation: Cardiovascular Imaging 10.11 (2017): e006979.

As this was a foundational project for pediatric echocardiography, it was important for the authors to share their experience so that others designing future large-scale studies using echo data can refer to this article as they plan their own research.  Amidst the COVID-19 lockdown, I had the pleasure of chatting (via Zoom) with two of the authors, Dr. Leo Lopez at Lucile Packard Children’s Hospital – Stanford University and Dr. Dongngan Truong at Primary Children’s Hospital – University of Utah about their work on this project.

Can you tell me a little bit about the background of why the PHN decided to do the normal echo database study?

Lopez: All of the z-score databases up until the time that we published our paper had limitations in terms of sample size, in terms of not paying attention to race and some not paying attention to sex, and some that all had very different statistical approaches in terms of determining what the Z scores are. So there was not a uniform way of doing that and we felt like the PHN was the perfect place to try and do a multicenter study where we can address all of the prior limitations to Z scores and that is how it came out. After we published the quantification paper in JASE (Lopez, Leo, et al. “Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council.” (Journal of the American Society of Echocardiography 23.5 (2010): 465-495) in 2010, one of the things that was discussed fairly regularly while we were drafting that paper was that it could serve as a manual of operations for a project like the PHN Z score project and so it almost felt like a natural offshoot from that original paper.

Click here to read the interview in full.