Department of Cardiovascular Medicine, Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio, USA.
JACC Cardiovasc Imaging. 2011 May;4(5):460-7. doi: 10.1016/j.jcmg.2011.01.016.
We sought the impact of recent recommendations on observer concordance on interpretation of diastolic stage and assessment of filling pressure.
Worsening stages of diastolic dysfunction are associated with worsening outcome. However, the echocardiographic classification of diastolic function is complex, and parameters may be discordant. The interobserver agreement of diastolic assessment is undefined.
A complete diastolic evaluation (transmitral flow, left atrial volume, tissue Doppler, pulmonary venous flow, mitral flow propagation, and left ventricular images) was obtained in 20 patients and interpreted by 14 experts in 8 countries (280 case reads). Each investigator was asked to interpret diastolic class and left ventricular filling pressure. Brain natriuretic peptide level was drawn on the same day of the echocardiogram to corroborate filling pressures obtained by the echocardiogram. Concordance was assessed as kappa, and accuracy was compared with specific application of the recommendations by 2 investigators.
For recognition of raised filling pressure, the sensitivity and specificity of readers for raised filling pressure defined by the reference read were 66 ± 37% and 88 ± 26%, respectively. Complete agreement among all readers was obtained in 10 of 20 cases. Diagnosis of normal and categories of abnormal filling was correct in 71% to 95%, with the lowest values obtained for normal and pseudonormal filling. There was no difference between U.S. and international readers. Not all patients in each diastolic stage showed all of the changes that are typical of that stage, and variations appeared to be attributable to differences in weighting of conflicting observations. Overall, kappa values for filling pressure and diastolic class were 0.71 (range 0.60 to 0.80) and 0.68 (range 0.54 to 0.86).
Correct results for estimation of filling pressure were obtained by a high proportion of readers. Classification of diastolic stages continues to be variable and might be addressed by provision of a uniform hierarchy of observations.
我们研究了观察者一致性对舒张期分期和充盈压评估的影响。
舒张功能障碍程度加重与预后恶化相关。然而，超声心动图对舒张功能的分类较为复杂，参数可能存在不一致。舒张期评估的观察者间一致性尚未确定。
对 20 例患者进行了完整的舒张期评估（二尖瓣血流、左心房容积、组织多普勒、肺静脉血流、二尖瓣血流传播和左心室图像），并由 8 个国家的 14 名专家进行了 280 次阅读。要求每位研究者评估舒张分期和左心室充盈压。在进行超声心动图检查的同一天抽取脑钠肽水平，以证实超声心动图获得的充盈压。采用 Kappa 评估一致性，并与 2 位研究者具体应用推荐标准的准确性进行比较。
在识别升高的充盈压方面，观察者对参考阅读中定义的升高充盈压的敏感性和特异性分别为 66%±37%和 88%±26%。在 20 例患者中，所有读者中有 10 例获得了完全一致的诊断。正常和异常充盈分类的诊断准确率为 71%至 95%，其中正常和假性正常充盈的准确率最低。美国和国际读者之间无差异。并非每个舒张期患者都表现出该期的所有典型变化，且变化似乎归因于对相互矛盾的观察结果的权重不同。总体而言，充盈压和舒张分期的 Kappa 值分别为 0.71（范围为 0.60 至 0.80）和 0.68（范围为 0.54 至 0.86）。
大部分读者都能获得正确的充盈压估计结果。舒张分期的分类仍然存在差异，可能需要通过提供统一的观察结果层级结构来解决。
