Abstract 12268: Reliability and Interobserver Concordance of Echocardiographic Diagnosis of Right Ventricular Size and Systolic Function - A Quality Control Exercise
Aims: RV size (RVS) and systolic function (RVSF) are important in a number of conditions but their assessment is challenging by echo. We sought the reliability and interobserver concordance of RV echo using qualitative and quantitative methods, in comparison with MRI and expert panel reading in a high volume echo lab.
Methods: We reviewed 360 echo reads for RV evaluation in 12 pts who had both echo and MRI indicated for RV assessment, evaluated by 15 readers. Readers were asked to visually estimate RVS and RVSF as normal, mild, moderate or severe, and then to reassess with quantitative measurements by adding RV dimensions, fractional area change, S', tricuspid annular plane systolic excursion and RV index of myocardial performance as per 2010 ASE Right Heart guideline. MRI was used as reference standard for grading of RVS and RVSF. Consensus echo reading from 3 experts was also used to define the severity of RVS in abnormal categories.
Results: The addition of quantitative measurements increased reliability and inter-reader agreement compared to qualitative assessment alone, especially in normal category (Figure). The overall average kappa increased from 0.28 to 0.55 across all levels of grading, and inter-class correlation coefficient increased from 0.63 to 0.76. In cases defined by MRI as normal or mildly abnormal, the average Kappa increased from 0.17 to 0.72 and percentage agreement for RVS increased from 58.5% to 87.5% (p ≤.0001) and for SF increased from 55.6% to 84.4% (p ≤.0001).
Conclusions: Visual estimation of RVS and RVSF are not reliable. Reliability improved with addition of quantitation, especially in defining the cases as normal or abnormal. The reliability of grading the abnormal cases in mild and moderate category remains inadequate, and further guidance is needed for the classification of abnormal categories.
- © 2011 by American Heart Association, Inc.