Ventricular Mechanics in Patients with Congenital Heart Disease and Cardiac Implantable Electronic Devices: An Echocardiography and Cardiac Computed Tomography Comparison Study.

Patients with congenital heart disease (CHD) and cardiac implantable electronic devices (CIEDs) are at risk for ventricular dysfunction. Cine cardiac computed tomography (CCT) is increasingly used for functional assessment, but its reproducibility among observers has not been described in this population. Patients who underwent CCT and echocardiogram within a 3-month interval without intervening intervention were reviewed. Inter-observer and inter-modality agreement for left ventricular (LV) volumes and ejection fraction (EF), qualitative right ventricular (RV) size and function, and presence of dyssynchrony were measured using kappa statistic and intraclass correlation coefficient (ICC). The study included 72 patients. There was excellent inter-observer agreement for LV volumes and LVEF by both echocardiography and CCT and moderate inter-modality agreement for all LV measurements. In patients with functional single ventricles, there was excellent inter-observer agreement for LV volumes and LVEF (ICC 0.99) by CCT and moderate agreement for LVEF by echocardiography (ICC 0.67). There was moderate agreement in RV size (κ = 0.70) and strong agreement in systolic function (κ = 0.83) by echocardiography and strong agreement in RV size (κ = 0.81) and excellent agreement in systolic function (κ = 0.96) by CCT. Dyssynchrony was observed in more than half of patients by CCT, with excellent inter-observer agreement for septal flash (κ = 0.99). In patients with CHD and CIEDs, CCT provides highly reproducible estimates of ventricular size and function, with stronger inter-observer agreement than echocardiography in patients with single ventricles and RV assessment. Septal flash may have utility as a qualitative marker of dyssynchrony in patients with CIEDs.