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Interobserver reliability of echocardiography for prognostication of normotensive patients with pulmonary embolism.

Kopecna D, Briongos S, Castillo H, Moreno C, Recio M, Navas P, Lobo JL, Alonso-Gomez A, Obieta-Fresnedo I, Fernández-Golfin C, Zamorano JL, Jiménez D, PROTECT investigato - Cardiovasc Ultrasound (2014)

Bottom Line: The intraclass correlation for the RV/LV diameter ratio was fair (0.55; 95% confidence interval [CI], 0.37-0.69), for the RV diameter was good (0.70; 95% CI, 0.56-0.80), and for the TAPSE measurement was very good (0.85; 95% CI, 0.77-0.90).On Bland-Altman analysis, the mean differences for RV diameter, RV/LV diameter ratio and TAPSE measurement were 2.33 (±5.38), 0.06 (±0.23) and 0.08 (±2.20), respectively.TAPSE measurement is the least user dependent and most reproducible echocardiographic finding of RV dysfunction in normotensive patients with PE.

View Article: PubMed Central - HTML - PubMed

Affiliation: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, 28034 Madrid, Spain. djc_69_98@yahoo.com.

ABSTRACT

Objectives: To evaluate the interobserver reliability of echocardiographic findings of right ventricle (RV) dysfunction for prognosticating normotensive patients with pulmonary embolism (PE).

Methods: A central panel of cardiologists evaluated echocardiographic studies of 75 patients included in the PROTECT study for the following signs: RV diameter, RV/left ventricular (LV) diameter ratio, hypokinesis of the RV free wall, and tricuspid plane systolic excursion (TAPSE). Investigators used intraclass correlation to assess agreement between the measurements of the central panel and each of the local cardiologists. Investigators used the single weighted kappa statistic to test for agreement between readers of interpretation of RV enlargement and RV hypokinesis.

Results: The two observers had fair agreement (k = 0.45) for RV enlargement assessed by the RV diameter, and good agreement (k = 0.65) for RV enlargement assessed by the RV/LV diameter ratio. The interobserver reliability of the assessment whether hypokinesis of the RV free wall is present was good (к = 0.70), and whether RV dysfunction (assessed by TAPSE measurement) is present was very good (k = 0.86). The intraclass correlation for the RV/LV diameter ratio was fair (0.55; 95% confidence interval [CI], 0.37-0.69), for the RV diameter was good (0.70; 95% CI, 0.56-0.80), and for the TAPSE measurement was very good (0.85; 95% CI, 0.77-0.90). On Bland-Altman analysis, the mean differences for RV diameter, RV/LV diameter ratio and TAPSE measurement were 2.33 (±5.38), 0.06 (±0.23) and 0.08 (±2.20), respectively.

Conclusion: TAPSE measurement is the least user dependent and most reproducible echocardiographic finding of RV dysfunction in normotensive patients with PE.

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Bland-Altman analysis of RV end-diastolic diameter measured by two cardiologists. Abbreviations: RVEDD, right ventricle end-diastolic diameter; SD, standard deviation.
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Figure 1: Bland-Altman analysis of RV end-diastolic diameter measured by two cardiologists. Abbreviations: RVEDD, right ventricle end-diastolic diameter; SD, standard deviation.

Mentions: The mean RVD end-diastolic diameter from the parasternal view measured by local and central cardiologist were 3.3 ± 0.7 cm and 3.1 ± 0.6 cm, respectively. The intraclass correlation was good (0.70; 95% CI, 0.56-0.80). On Bland-Altman analysis of RV end-diastolic diameter measurements, the means and standard deviation (SD) between central and local cardiologists were 2.33 and 5.38, respectively (Figure 1). When RV dysfunction was defined as a RV end-diastolic diameter > 30 mm from the parasternal view, the two observers agreed that in 23 patients (32%; 95% CI, 21-42%) no RV dysfunction was present. The two observers agreed that RV dysfunction was present in 30 patients (41%; 95% CI, 30-52%); disagreement whether residual occurred in 20 patients (27%; 95% CI, 17-38%) (Table 2). The interobserver agreement whether RV dysfunction is present or not is fair, with a weighted kappa of 0.45 (95% CI, 0.25-0.65).


Interobserver reliability of echocardiography for prognostication of normotensive patients with pulmonary embolism.

Kopecna D, Briongos S, Castillo H, Moreno C, Recio M, Navas P, Lobo JL, Alonso-Gomez A, Obieta-Fresnedo I, Fernández-Golfin C, Zamorano JL, Jiménez D, PROTECT investigato - Cardiovasc Ultrasound (2014)

Bland-Altman analysis of RV end-diastolic diameter measured by two cardiologists. Abbreviations: RVEDD, right ventricle end-diastolic diameter; SD, standard deviation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126908&req=5

Figure 1: Bland-Altman analysis of RV end-diastolic diameter measured by two cardiologists. Abbreviations: RVEDD, right ventricle end-diastolic diameter; SD, standard deviation.
Mentions: The mean RVD end-diastolic diameter from the parasternal view measured by local and central cardiologist were 3.3 ± 0.7 cm and 3.1 ± 0.6 cm, respectively. The intraclass correlation was good (0.70; 95% CI, 0.56-0.80). On Bland-Altman analysis of RV end-diastolic diameter measurements, the means and standard deviation (SD) between central and local cardiologists were 2.33 and 5.38, respectively (Figure 1). When RV dysfunction was defined as a RV end-diastolic diameter > 30 mm from the parasternal view, the two observers agreed that in 23 patients (32%; 95% CI, 21-42%) no RV dysfunction was present. The two observers agreed that RV dysfunction was present in 30 patients (41%; 95% CI, 30-52%); disagreement whether residual occurred in 20 patients (27%; 95% CI, 17-38%) (Table 2). The interobserver agreement whether RV dysfunction is present or not is fair, with a weighted kappa of 0.45 (95% CI, 0.25-0.65).

Bottom Line: The intraclass correlation for the RV/LV diameter ratio was fair (0.55; 95% confidence interval [CI], 0.37-0.69), for the RV diameter was good (0.70; 95% CI, 0.56-0.80), and for the TAPSE measurement was very good (0.85; 95% CI, 0.77-0.90).On Bland-Altman analysis, the mean differences for RV diameter, RV/LV diameter ratio and TAPSE measurement were 2.33 (±5.38), 0.06 (±0.23) and 0.08 (±2.20), respectively.TAPSE measurement is the least user dependent and most reproducible echocardiographic finding of RV dysfunction in normotensive patients with PE.

View Article: PubMed Central - HTML - PubMed

Affiliation: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, 28034 Madrid, Spain. djc_69_98@yahoo.com.

ABSTRACT

Objectives: To evaluate the interobserver reliability of echocardiographic findings of right ventricle (RV) dysfunction for prognosticating normotensive patients with pulmonary embolism (PE).

Methods: A central panel of cardiologists evaluated echocardiographic studies of 75 patients included in the PROTECT study for the following signs: RV diameter, RV/left ventricular (LV) diameter ratio, hypokinesis of the RV free wall, and tricuspid plane systolic excursion (TAPSE). Investigators used intraclass correlation to assess agreement between the measurements of the central panel and each of the local cardiologists. Investigators used the single weighted kappa statistic to test for agreement between readers of interpretation of RV enlargement and RV hypokinesis.

Results: The two observers had fair agreement (k = 0.45) for RV enlargement assessed by the RV diameter, and good agreement (k = 0.65) for RV enlargement assessed by the RV/LV diameter ratio. The interobserver reliability of the assessment whether hypokinesis of the RV free wall is present was good (к = 0.70), and whether RV dysfunction (assessed by TAPSE measurement) is present was very good (k = 0.86). The intraclass correlation for the RV/LV diameter ratio was fair (0.55; 95% confidence interval [CI], 0.37-0.69), for the RV diameter was good (0.70; 95% CI, 0.56-0.80), and for the TAPSE measurement was very good (0.85; 95% CI, 0.77-0.90). On Bland-Altman analysis, the mean differences for RV diameter, RV/LV diameter ratio and TAPSE measurement were 2.33 (±5.38), 0.06 (±0.23) and 0.08 (±2.20), respectively.

Conclusion: TAPSE measurement is the least user dependent and most reproducible echocardiographic finding of RV dysfunction in normotensive patients with PE.

Show MeSH
Related in: MedlinePlus