Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise

Ling, Lee Fong, Obuchowski, Nancy A., Rodriguez, Leonardo, Popovic, Zoran, Kwon, Deborah and Marwick, Thomas H. (2012) Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise. Journal of the American Society of Echocardiography, 25 7: 709-713.


Author Ling, Lee Fong
Obuchowski, Nancy A.
Rodriguez, Leonardo
Popovic, Zoran
Kwon, Deborah
Marwick, Thomas H.
Title Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise
Journal name Journal of the American Society of Echocardiography  (ERA 2012 Listed)    (ERA 2010 Rank B)   Check publisher's open access policy
Publication date 2012-07
Sub-type Article
DOI 10.1016/j.echo.2012.03.018
Volume number 25
Issue number 7
ISSN 0894-7317;1097-6795
Start page 709
End page 713
Total pages 5
Place of publication Philadelphia, PA, United States
Publisher Mosby
Collection year 2013
Language eng
Formatted abstract Background
Accurate assessment of right ventricular (RV) size (RVS) and RV systolic function (RVSF) is vital in the management of various conditions, but their assessment is challenging using echocardiography. The aim of this study was to determine the accuracy and interobserver concordance of qualitative and quantitative RV echocardiography.

Methods
Fifteen readers evaluated RV function in 12 patients (360 readings) who underwent echocardiography and cardiac magnetic resonance for RV assessment. Readers qualitatively estimated RVS and RVSF as normal, mild, moderate, or severe and then reassessed quantitatively by adding RV dimensions, fractional area change, S′, tricuspid annular plane systolic excursion, and RV index of myocardial performance. Cardiac magnetic resonance was used as the reference standard for grading RVS and RVSF.

Results
Quantitative measurements increased accuracy and interreader agreement compared to qualitative assessment alone, especially in normal categories. Readers’ accuracy for diagnosing normal and severe RVS increased from 38% to 78% (P = .001) and from 70% to 97% (P = .018), and readers’ accuracy for diagnosing normal and mild RVSF increased from 52% to 84% (P < .001) and from 36% to 56% (P = .001). Interreader agreement for classification of the subjects as normal or abnormal improved from a κ value of 0.40 to 0.77 (fair to good agreement) for RVS and from 0.43 to 0.66 (moderate to good agreement) for RVSF.

Conclusions
Visual estimation of RVS and RVSF is inaccurate and has wide interobserver variability. Quantitation improves accuracy and reliability, especially in distinction of normal and abnormal. The reliability of mild and moderate grades remains inadequate, and further guidance is needed for the classification of abnormal categories.
Keyword Quality control
Right ventricular
Cardiac magnetic resonance
Echocardiography
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article
Collections: Non HERDC
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Created: Fri, 06 Jul 2012, 12:09:46 EST by Matthew Lamb on behalf of School of Medicine