Clinical InvestigationRight Ventricular Size and FunctionAccuracy and Interobserver Concordance of Echocardiographic Assessment of Right Ventricular Size and Systolic Function: A Quality Control Exercise
Section snippets
Patients
Studies from 12 patients (mean age, 52 ± 19 years; six women) undergoing RV assessment with both echocardiography and CMR imaging performed within 24 hours were selected retrospectively. Five patients had grade 3 or 4+ tricuspid regurgitation, two had grade 3 or 4+ pulmonary regurgitation, three had undergone right-sided valvular repair, one presented for shunt evaluation, and one presented for for evaluation of possible constriction. The institutional review board approved this study.
Echocardiography
Accuracy
The readers’ overall accuracy for diagnosing normal, mild, moderate, and severe RVS and normal, mild, and moderate RVSF is shown in Table 1, Table 2. With only visual scoring, readers had poor accuracy in characterizing RVS as normal, mild, and even moderate. Over a quarter of normal cases were reported as moderate or severe RVS. Visual scoring had 70% accuracy for diagnosis of severe RVS, with 27% of severe cases interpreted as moderate. The addition of quantification correctly classified 78%
Discussion
The main findings of this study are that (1) visual estimation of RVS and RVSF is inaccurate, with significant interrater variability; (2) the addition of quantification improved accuracy and reduced interrater variability (especially in the differentiation of normal and abnormal cases; and (3) the reliability of grading the abnormal cases in mild and moderate categories remains inadequate.
Conclusions
Visual assessment of RVS and RVSF is inaccurate and shows considerable variability. The addition of quantitative assessment yields improved accuracy and decreased variability, especially in relation to defining the normality of the right ventricle. The reliability of grading mild and moderate abnormalities remains inadequate, and further guidance is needed for the classification of abnormal categories.
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