Defining the real-world reproducibility of visual grading of left ventricular function?and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation

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• 作者：Graham D. Cole ; Niti M. Dhutia…
• 关键词：Echocardiography ; Ventricular function ; Heart failure ; Reproducibility of results
• 刊名：The International Journal of Cardiovascular Imaging (formerly Cardiac Imaging)
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：31
• 期：7
• 页码：1303-1314
• 全文大小：813 KB
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• 作者单位：Graham D. Cole (1)
  Niti M. Dhutia (1)
  Matthew J. Shun-Shin (1)
  Keith Willson (1)
  James Harrison (2)
  Claire E. Raphael (3)
  Massoud Zolgharni (1)
  Jamil Mayet (1)
  Darrel P. Francis (1)
  
  1. International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London, W2 1LA, UK
  2. Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
  3. Royal Brompton Hospital, London, UK
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  
• 出版者：Springer Netherlands
• ISSN：1573-0743

文摘

Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1-0) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an “eyeball-EF estimate and (3) an image quality rating on a 0-00 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator’s chance of agreement with another operator was 50 % and with themself on blinded re-presentation was 68 %. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators-assessments, correlated with EF estimate variability (r = ?.616, p < 0.01) and visual grading agreement (r = 0.58, p < 0.01). However, operators-own single quality assessments were not a useful forewarning of their estimate being an outlier, partly because individual quality assessments had poor within-operator reproducibility (SD of difference 17.8). Reproducibility of visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change. Keywords Echocardiography Ventricular function Heart failure Reproducibility of results