Reliability of visual assessment of global and segmental left ventricular function: a multicenter study by the Israeli Echocardiography Research Group.
Blondheim DS, Beeri R, Feinberg MS, Vaturi M, Shimoni S, Fehske W, Sagie A, Rosenmann D, Lysyansky P, Deutsch L, Leitman M, Kuperstein R, Hay I, Gilon D, Friedman Z, Agmon Y, Tsadok Y, Liel-Cohen N.
J Am Soc Echocardiogr. 2010 Mar;23(3):265-6. Abstract
BACKGROUND: The purpose of this multicenter study was to determine the reliability of visual assessments of segmental wall motion (WM) abnormalities and global left ventricular function among highly experienced echocardiographers using contemporary echocardiographic technology in patients with a variety of cardiac conditions.
METHODS: The reliability of visual determinations of left ventricular WM and global function was calculated from assessments made by 12 experienced echocardiographers on 105 echocardiograms recorded using contemporary echocardiographic equipment. Ten studies were reread independently to determine intraobserver reliability.
RESULTS: Interobserver reliability for visual differentiation between normal, hypokinetic, and akinetic segments had an intraclass correlation coefficient of 0.70. The intraclass correlation coefficient for dichotomizing segments into normal versus other abnormal was 0.63, for hypokinetic versus other scores was 0.26, and for akinetic versus other scores was 0.58. Similar results were found for intraobserver reliability. Interobserver reliability for WM score index was 0.84 and for left ventricular ejection fraction was 0.78. Similar values were obtained for the intraobserver reliability of WM score index and ejection fraction. Compared to angiographic data, the accuracy of segmental WM assessments was 85%, and correct determination of the culprit artery was achieved in 59% of patients with myocardial infarctions.
ICCs for intraobserver reliability for trichotomous ordinal scoring (normal, hypokinetic, and akinetic segments) and for dichotomous scoring (each score classification vs the other scores) for each reader. Ranges of the ICCs considered poor, moderate, good, and excellent are specified. Colors represent results of ndividual readers. Note worst results (ie, lowest reliability) for hypokinetic segments.
CONCLUSION: Among experienced readers using contemporary echocardiographic equipment, interobserver and intraobserver reliability was reasonable for the visual quantification of normal and akinetic segments but poor for hypokinetic segments. Reliability was good for the visual assessment of global left ventricular function by WM score index and ejection fraction.
... In summary, the advantages and disadvantages of the longsurviving visual assessment of left ventricular function depend on the application and on the experience of the interpreter. In clinical practice, the visual approach will be around for quite a while, because of its proven clinical usefulness and because the incremental value of quantitative information for decision making cannot justify the additional resources required for semiautomated or automated quantitative assessment of segmental and global left ventricular function, at least in the majority of cases. That having been said, echocardiographers should keep an open mind and use the full armamentarium of modern equipment in challenging cases or when quantitative documentation is important. In this direction, only standardization, continuous education, and quality improvement (ie, teamwork) in the echocardiography lab can bring the integration of newer echocardiographic modalities in clinical practice while ensuring consistency of results obtained with either traditional or digital approaches.
Recomendo a todos darem uma lida no estudo e no editorial.
Atlanta, Georgia
Visual Assessment of Left Ventricular Function in the Era of High Definition: The Machine and the Eye of the Beholder
Andreas P. Kalogeropoulos, MD, and Randolph P. Martin, MD, FASE,
Editorial Comment
... In summary, the advantages and disadvantages of the longsurviving visual assessment of left ventricular function depend on the application and on the experience of the interpreter. In clinical practice, the visual approach will be around for quite a while, because of its proven clinical usefulness and because the incremental value of quantitative information for decision making cannot justify the additional resources required for semiautomated or automated quantitative assessment of segmental and global left ventricular function, at least in the majority of cases. That having been said, echocardiographers should keep an open mind and use the full armamentarium of modern equipment in challenging cases or when quantitative documentation is important. In this direction, only standardization, continuous education, and quality improvement (ie, teamwork) in the echocardiography lab can bring the integration of newer echocardiographic modalities in clinical practice while ensuring consistency of results obtained with either traditional or digital approaches.
Journal of the American Society of Echocardiography, March 2010
Recomendo a todos darem uma lida no estudo e no editorial.
Atlanta, Georgia
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