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Echocardiographic Diagnosis of Rheumatic Heart Disease: Substantial Agreement, Inter-Rater Reliability and Accuracy
Jacqueline M Williamson1, Gillian A Whalley2, Peter S Morris3
1Menzies School of Health Research, Darwin, NT, Australia; Charles Darwin University, Darwin, NT, Australia.
Insights
Cardiac sonographers demonstrate high accuracy and agreement comparable to cardiologists in detecting Rheumatic Heart Disease (RHD). These findings support task-sharing for RHD screening, improving access in underserved populations.
Area of Science:
- Cardiology
- Public Health
- Medical Imaging
Background:
- Rheumatic Heart Disease (RHD) disproportionately affects socially disadvantaged populations.
- Current RHD detection methods are resource-intensive, highlighting the need for efficient screening strategies.
- Task-sharing with cardiac sonographers may enhance access to RHD screening.
Purpose of the Study:
- To assess the accuracy of cardiac sonographers in echocardiographic RHD evaluation.
- To compare agreement and inter-rater reliability between sonographers and cardiologists for RHD detection.
- To evaluate the feasibility of task-sharing for RHD screening.
Main Methods:
- Four pediatric cardiologists and seven cardiac sonographers independently reported 210 echocardiograms.
- Assessors were blinded to other results and expert panel diagnoses.
- Agreement (Cohen's kappa, Fleiss' kappa) and accuracy (sensitivity, specificity) were analyzed against a consensus expert diagnosis.
Main Results:
- Substantial agreement was found between sonographers and cardiologists for detecting any abnormality (k=0.74), any RHD (k=0.79), and definite RHD (k=0.78).
- High accuracy was observed: median cardiologist sensitivity 79%, specificity 97%; median sonographer sensitivity 83%, specificity 93% for any RHD.
- Inter-rater reliability was strong within both professional groups.
Conclusions:
- Expert cardiac sonographers achieve agreement, reliability, and accuracy comparable to expert cardiologists in RHD echocardiographic reporting.
- These results validate the use of task-sharing for echocardiographic RHD detection.
- Task-sharing can potentially improve RHD screening accessibility and efficiency.
Background:
Rheumatic heart disease (RHD) rates remain high in many socially disadvantaged populations. Early detection through active case finding is resource intensive and task-sharing with cardiac sonographers may improve access to screening. The accuracy of cardiac sonographers in the echocardiographic evaluation of RHD has not previously been assessed. The 2012 World Heart Federation guidelines were used to compare agreement, inter-rater reliability, and accuracy between cardiac sonographers and cardiologists in the echocardiographic evaluation of RHD.
Method:
Four paediatric cardiologists and seven cardiac sonographers underwent structured training before independently reporting the same 210 echocardiograms (a total of 2,310 individual studies). Participants were blind to the results of other assessors and blind to the original diagnoses by a three-person expert panel consensus. Median results from each group of professionals were compared to each other and the original diagnosis. Individual results were also analysed to determine agreement with the original panel diagnosis using Cohen's kappa. Inter-rater agreement for multiple assessors in each group was determined using Fleiss' kappa. Sensitivity, specificity, and likelihood ratios were estimated using the original panel diagnosis as the reference standard.
Results:
The agreement was substantial between median cardiac sonographer and median cardiologist results for the detection of any abnormality (k=0.74, 95% CI 0.61-0.88); any RHD (k=0.79, 95% CI 0.65-0.92); and definite RHD (k=0.78, 95% CI 0.64-0.91). Accuracy for the detection of any RHD was high with sensitivity of median cardiologist results of 79% (95% CI 71%-86%) and specificity of 97% (95% CI 87%-99%) and median sonographer sensitivity was 83% (95% CI 75%-89%) with specificity of 93% (95% CI 85%-98%).
Conclusions:
Expert cardiac sonographers achieved a similar level of agreement, inter-rater reliability, and accuracy to expert cardiologists in the reporting of RHD. These findings support the use of task-sharing for the echocardiographic detection of RHD.
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