Gottdiener John S, Panza Julio A, St John Sutton Martin, Bannon Patrick, Kushner Harvey, Weissman Neil J
St Francis Hospital, Roslyn, NY 11576, USA.
Am Heart J. 2002 Jul;144(1):115-21. doi: 10.1067/mhj.2002.123139.
Substantial variability in serial echocardiographic qualitative assessment of valvular regurgitation may exist. Reader variability is generally well understood, but acquisition variability (portions of variability caused by equipment, sonographers, physiologic changes) has been less frequently assessed, particularly in combination with reader variability. We attempted to determine the relative contributions of acquisition and reader variability as components of total test-retest variability for aortic (AR) and mitral (MR) regurgitation.
Outpatient echocardiographic study was done at 2 clinical sites. Twenty-three predominantly obese middle-aged females had 3 echocardiograms, 2 performed 14 +/- 3 days apart and the third performed within 1 to 2 hours of the second. Triplets of echocardiograms were evaluated for change in grade of AR and MR. Medical history, anthropometrics, and blood pressures were obtained.
Average intrareader variability (percentage of reads for which there is within-reader disagreement) was 5.6% for AR and 16.7% for MR. The average total test-retest variability (percentage of reads for which there is disagreement between visits) was 29.0% for AR and 24.6% for MR. The acquisition variability for AR was 23.4% +/- 7.7%; for MR, it was 7.9% +/- 10.2%. A significant predictor of change for AR/MR was the initial grade. Change in diastolic blood pressure was positively associated with change in AR and MR.
Intrareader agreement was substantial for AR and MR. Components of total test-retest variability found were reader, biological (change in diastolic blood pressure), and regression to the mean. Recommendations for clinical practice include monitoring blood pressure changes and understanding the confidence limits of the clinical test. Test-retest variability and its components should be considered in echocardiography and other diagnostic testing.
在连续超声心动图对瓣膜反流的定性评估中可能存在显著差异。读者间的变异性通常已得到充分理解，但采集变异性（由设备、超声检查人员、生理变化引起的部分变异性）较少受到评估，尤其是与读者变异性结合起来评估。我们试图确定采集变异性和读者变异性作为主动脉瓣反流（AR）和二尖瓣反流（MR）总重测变异性组成部分的相对贡献。
在2个临床地点进行门诊超声心动图研究。23名主要为肥胖的中年女性接受了3次超声心动图检查，其中2次检查间隔14±3天进行，第3次检查在第2次检查的1至2小时内进行。对三联超声心动图评估AR和MR分级的变化。获取病史、人体测量学数据和血压。
AR的平均读者内变异性（读者内意见不一致的读数百分比）为5.6%，MR为16.7%。AR的平均总重测变异性（不同次检查间意见不一致的读数百分比）为29.0%，MR为24.6%。AR的采集变异性为23.4%±7.7%；MR的采集变异性为7.9%±10.2%。AR/MR变化的一个显著预测因素是初始分级。舒张压变化与AR和MR变化呈正相关。
AR和MR的读者内一致性较高。发现的总重测变异性组成部分包括读者、生物学因素（舒张压变化）和均值回归。临床实践建议包括监测血压变化并了解临床检查的置信限。在超声心动图和其他诊断检查中应考虑重测变异性及其组成部分。
