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


Ling, LF and Obuchowski, NA and Rodriguez, L and Popovic, Z and Kwon, D and Marwick, TH, 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) pp. 709-713. ISSN 0894-7317 (2012) [Refereed Article]

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Copyright 2012 American Society of Echocardiography

DOI: doi:10.1016/j.echo.2012.03.018


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.

Item Details

Item Type:Refereed Article
Keywords:quality control, right ventricular, cardiac magnetic resonance, echocardiography
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:91212
Year Published:2012
Web of Science® Times Cited:93
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-05-12
Last Modified:2014-12-17

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