Abstract 15392: Not Lost in Translation - An International Multicenter Study of Concordance of Diastolic Function Evaluation After the Publication of Guidelines
Background: Echocardiographic assessment of diastolic function is prognostically important but also complex. Recent guidelines have sought to standardize this assessment but the impact of guidelines on observer concordance is undefined. We sought the interpretation of diastolic class and assessment of filling pressure.
Methods: 20 consecutive pts were identified with complete diastolic evaluation (transmitral flow, LA volume, tissue Doppler, pulmonary venous flow, mitral flow propagation, LV images), and interpreted by 11 experts in 7 countries (220 case reads). Each investigator was asked to interpret diastolic class and LV filling pressure. Concordance was assessed as kappa and accuracy was compared to specific application of the ASE guidelines by one investigator.
Results: For recognition of raised filling pressure, complete agreement between all readers was obtained in 10 of 20 cases, and the sensitivity and specificity were similar (Table). Diagnosis of normal and categories of abnormal filling were correct in from 71–95%, with similar results for US and non-US readers (Table). Variations appeared to be attributable to differences in weighting of conflicting observations. Overall, kappa values for filling pressure was 0.71 (range 0.60–0.80) and for class was 0.68 (range 0.54–0.86)
Conclusions: Correct results for estimation of filling pressure are obtained in a high proportion of readers, irrespective of location. Classification of diastolic stage continues to be variable and might be addressed by provision of a uniform hierarchy of observations.
- © 2010 by American Heart Association, Inc.