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Updated: Sep 28, 2025
Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats
Published on: December 13, 2019
Interrater reproducibility of the 2016 American society of echocardiography left ventricular diastolic function
Jonathan M Wong1, Christiane M Abouzeid2, Thuy D Nguyen3
1California Pacific Medical Center, San Francisco, California, USA.
Insights
This study found excellent interreader reliability for Doppler measurements but only moderate agreement for grading diastolic dysfunction using 2016 guidelines. This highlights variability in assessing diastolic dysfunction.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Limited data exist on interreader variability in diastolic measurements.
- The 2016 American Society of Echocardiography (ASE) guidelines for left ventricular (LV) diastolic function are widely used.
- Understanding variability in applying these guidelines is crucial for accurate diagnosis.
Purpose of the Study:
- To assess interreader variability of diastolic measurements.
- To evaluate the agreement in grading diastolic dysfunction (DD) using the 2016 ASE/EACVI guidelines.
- To identify predictors of disagreement in DD grading.
Main Methods:
- 49 volunteers from a cardiology practice were recruited.
- Diastolic dysfunction (DD) presence and grade were determined using the 2016 LV diastolic function guideline algorithm.
- Interclass correlation coefficients (ICC) and Fleiss K-statistics were calculated to assess agreement.
Main Results:
- Excellent interreader reliability (ICC > .90) was observed for mitral inflow and tissue Doppler velocities.
- Moderate-good reliability (ICC .80-.86) was found for LV volumes, and moderate reliability (ICC .56) for LA volume.
- Agreement for DD presence (K = .68) and grade (K = .59) was moderate-good but not excellent.
Conclusions:
- The 2016 ASE/EACVI diastolic guidelines demonstrate excellent interrater reliability for Doppler measurements.
- Volumetric measurements show moderate-good interrater reliability.
- Agreement on the overall diastolic grade is moderate-good, indicating areas for potential improvement in guideline application.
Background:
Little data exist regarding interreader variability of diastolic measurements and their application by the 2016 American Society of Echocardiography left ventricular (LV) diastolic function guidelines.
Methods:
Volunteers (n = 49) were recruited from an outpatient cardiology practice. The presence and grade of diastology dysfunction (DD) was determined by the 2016 LV diastology guideline algorithm. We determined the mean, standard deviation, coefficient of variation, and intraclass correlation coefficient (ICC) for each measurement and Fleiss K-statistic to define differences in grading DD. We determined predictors associated with disagreement of DD grade using odds ratios.
Results:
The mean LVEF was 56%, LAVI 32 ml/m2 , and peak TR velocity was 2.3 m/s. The ICC for mitral inflow and tissue Doppler velocities were >.90, for LV volumes were .80-.86, and for LA volume was .56. The Fleiss K-value for the agreement of the presence of DD was .68 and for DD grade was .59. Variables with increased odds of disagreement were (1) at least one reader considering a TR signal uninterpretable (OR 12.0; 95% CI 1.3-109.6), (2) at least one reader assessing both LVEF 50%-55% and LAVI 29-39 ml/m2 (OR 9.3; 95% CI 1.0-87), and (3) at least one reader assessing LVEF 50-55% (OR 3.8; 95% CI 1.1-13.4).
Conclusions:
Using the 2016 ASE/EACVI diastology guidelines, we found excellent interrater reliability of Doppler measurements, moderate-good interrater reliability of volumetric measurements, and moderate-good but not excellent agreement for diastology grade.
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