Effect of recommendations on interobserver consistency of diastolic function evaluation.
Samuel Unzek1, Zoran B Popovic, Thomas H Marwick
1Department of Cardiovascular Medicine, Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio, USA.
JACC. Cardiovascular Imaging
|May 14, 2011
Summary
Recent recommendations improved observer agreement on diastolic function assessment, though classification variability persists. Standardizing observation hierarchy may further enhance accuracy in evaluating diastolic stages and filling pressures.
Area of Science:
- Cardiology
- Echocardiography
- Diastology
Background:
- Diastolic dysfunction stages correlate with patient outcomes.
- Echocardiographic assessment of diastolic function is complex and can yield discordant parameters.
- Interobserver agreement for diastolic assessment requires definition.
Purpose of the Study:
- To evaluate the impact of recent guidelines on interobserver agreement for diastolic stage and filling pressure interpretation.
- To assess the concordance among experts in classifying diastolic function and estimating filling pressures.
Main Methods:
- Complete diastolic evaluations were performed on 20 patients.
- 14 international experts interpreted echocardiographic parameters and filling pressures.
- Concordance was measured using kappa statistics; accuracy was compared against reference reads.
Main Results:
- Sensitivity and specificity for raised filling pressure were 66% ± 37% and 88% ± 26%, respectively.
- Complete agreement among all readers occurred in 50% of cases.
- Kappa values for filling pressure and diastolic class were 0.71 and 0.68, respectively, indicating substantial agreement.
Conclusions:
- A high proportion of readers accurately estimated filling pressures.
- Classification of diastolic stages remains variable, suggesting a need for a standardized observation hierarchy.
- Recent recommendations show promise but further standardization is needed for consistent diastolic assessment.
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