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Comparative Study
. 2019 Dec;12(1):e008122.
doi: 10.1161/CIRCIMAGING.118.008122.

Interobserver Variability in Applying American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 Guidelines for Estimation of Left Ventricular Filling Pressure

Sherif F Nagueh  1 , Theodore P Abraham  2   3 , Gerard P Aurigemma, Jeroen J Bax  4 , Carmen Beladan  5 , Alyssa Browning  3 , Mohammed A Chamsi-Pasha  1 , Victoria Delgado  4 , Genevieve Derumeaux  6 , Giulia Dolci  4 , Erwan Donal  7 , Thor Edvardsen  8 , Kinan Carlos El Tallawi  1 , Laura Ernande  6 , Roberta Esposito  9 , Frank A Flachskampf  10 , Maurizio Galderisi  9 , James Gentry  11 , Steven A Goldstein  12 , Serge C Harb  11 , Arnaud Hubert  7 , Judy Hung  13 , Allan L Klein  11 , Patrizio Lancellotti  14 , Redah Z Mahmood  12 , Paolo Marino  15 , Bogdan A Popescu  5 , Martina Previato  6 , Saket R Sanghai  2 , Otto A Smiseth  8 , Jiaqiong Xu  1 ; for Diastolic Function Assessment Collaborators
Affiliations
Free article
Comparative Study

Interobserver Variability in Applying American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 Guidelines for Estimation of Left Ventricular Filling Pressure

Sherif F Nagueh et al. Circ Cardiovasc Imaging. 2019 Dec.
Free article

Abstract

Background: Assessment of left ventricular (LV) filling pressure is among the important components of a comprehensive echocardiographic report. Previous studies noted wide limits of agreement using 2009 American Society of Echocardiography/European Association of Echocardiography guidelines, but reproducibility of 2016 guidelines update in estimating LV filling pressure is unknown.

Methods: Echocardiographic and hemodynamic data were obtained from 50 patients undergoing cardiac catheterization for clinical indications. Clinical and echocardiographic findings but not invasive hemodynamics were provided to 4 groups of observers, including experienced echocardiographers and cardiology fellows. Invasively acquired LV filling pressure was the gold standard.

Results: In group I of 8 experienced echocardiographers from the guidelines writing committee, sensitivity for elevated LV filling pressure was 92% for all observers, and specificity was 93±6%. Fleiss κ-value for the agreement in group I was 0.80. In group II of 4 fellows in training, sensitivity was 91±2%, and specificity was 95±2%. Fleiss κ-value for the agreement in group II was 0.94. In group III of 9 experienced echocardiographers who had not participated in drafting the guidelines, sensitivity was 88±5%, and specificity was 91±7%. Fleiss κ-value for the agreement in group III was 0.76. In group IV of 7 other fellows, sensitivity was 91±3%, and specificity was 92±5%. Fleiss κ-value for the agreement in group IV was 0.89.

Conclusions: There is a good level of agreement and accuracy in the estimation of LV filling pressure using the American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 recommendations update, irrespective of the experience level of the observer.

Keywords: diastole; echocardiography; echocardiography, Doppler; guideline; humans.

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