Hien Maximilian Dominik, Großgasteiger Manuel, Weymann Alexander, Rauch Helmut, Rosendal Christian
Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany; Department of Pediatrics, University of Heidelberg, Heidelberg, Germany; Research Training Group 1126, German Research Foundation (DFG), Bonn, Germany.
Echocardiography. 2014 Mar;31(3):311-7. doi: 10.1111/echo.12365. Epub 2013 Sep 13.
Three-dimensional transesophageal echocardiography (3DTEE) has been demonstrated to provide more accurate information than two-dimensional transesophageal echocardiography (2DTEE) in the localization of mitral valve prolapse (MVP). However, most studies have been single-rater studies. Few results were tested for inter-observer variability with a single second rater. This multicenter study aimed to determine reliability of 2D and 3DTEE mitral valve evaluations by calculating inter-observer agreement between various echocardiographers.
Fifteen observers from 4 institutions in Germany and Switzerland interpreted 2D and 3DTEE images from 6 patients selected to represent a large spectrum of MVP diversity. Surgical findings served as reference. Individual assessments of MVP and ruptured chordae tendineae (ChR) pathology were compared by calculating Randolph's free-marginal multirater kappa coefficient.
Accuracy of MVP evaluation with 3DTEE was 83.9%, CI [81.0%; 86.8%] and 78.7% CI [76.6% 80.8%] with 2DTEE. Flail leaflets with chordal ruptures were described correctly in 91.1%, CI [85.8, 96.4] with 3D compared to 71.1%, CI [65.0, 77.2] with 2DTEE. The multirater kappa coefficient of inter-observer agreement among all 15 observers was κ = 0.65/0.58 for 3D/2D evaluation of MVP and κ = 0.70/0.54 for detection of ChR.
Three-dimensional assessment of MVP was superior to 2DTEE, although the accuracy of both 3DTEE and 2DTEE was found to be lower than previously published. 3D MVP assessment is less operator dependent than 2DTEE evaluation. Although validity has been demonstrated before, we provide evidence that 3DTEE is reproducible among 15 observers and is a reliable method for MVP evaluation.
三维经食管超声心动图（3DTEE）已被证明在二尖瓣脱垂（MVP）定位方面比二维经食管超声心动图（2DTEE）能提供更准确的信息。然而，大多数研究都是单观察者研究。很少有结果通过单一的第二观察者来测试观察者间的变异性。这项多中心研究旨在通过计算不同超声心动图医生之间的观察者间一致性来确定2D和3DTEE对二尖瓣评估的可靠性。
来自德国和瑞士4家机构的15名观察者解读了6名患者的2D和3DTEE图像，这些患者被选来代表广泛的MVP多样性。手术结果作为参考。通过计算伦道夫自由边缘多观察者kappa系数，比较了对MVP和腱索断裂（ChR）病理的个体评估。
3DTEE对MVP评估的准确率为83.9%，CI[81.0%；86.8%]，2DTEE为78.7%，CI[76.6%，80.8%]。与2DTEE相比，3D对伴有腱索断裂的连枷叶瓣的正确描述率为91.1%，CI[85.8，96.4]，2DTEE为71.1%，CI[65.0，77.2]。所有15名观察者间一致性的多观察者kappa系数，3D/2D对MVP评估为κ = 0.65/0.58，检测ChR为κ = 0.70/0.54。
MVP的三维评估优于2DTEE，尽管发现3DTEE和2DTEE的准确率均低于先前发表的结果。3D MVP评估比2DTEE评估对操作者的依赖性更小。虽然之前已证明其有效性，但我们提供的证据表明，3DTEE在15名观察者之间具有可重复性，是一种可靠的MVP评估方法。
