Vorselaars V M M, Velthuis S, Huitema M P, Hosman A E, Westermann C J J, Snijder R J, Mager J J, Post M C
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Neth Heart J. 2018 Apr;26(4):203-209. doi: 10.1007/s12471-018-1094-4.
Transthoracic contrast echocardiography (TTCE) is recommended for screening of pulmonary arteriovenous malformations (PAVMs) in hereditary haemorrhagic telangiectasia. Shunt quantification is used to find treatable PAVMs. So far, there has been no study investigating the reproducibility of this diagnostic test. Therefore, this study aimed to describe inter-observer and inter-injection variability of TTCE.
We conducted a prospective single centre study. We included all consecutive persons screened for presence of PAVMs in association with hereditary haemorrhagic telangiectasia in 2015. The videos of two contrast injections per patient were divided and reviewed by two cardiologists blinded for patient data. Pulmonary right-to-left shunts were graded using a three-grade scale. Inter-observer and inter-injection agreement was calculated with κ statistics for the presence and grade of pulmonary right-to-left shunts.
We included 107 persons (accounting for 214 injections) (49.5% male, mean age 45.0 ± 16.6 years). A pulmonary right-to-left shunt was present in 136 (63.6%) and 131 (61.2%) injections for observer 1 and 2, respectively. Inter-injection agreement for the presence of pulmonary right-to-left shunts was 0.96 (95% confidence interval (CI) 0.9-1.0) and 0.98 (95% CI 0.94-1.00) for observer 1 and 2, respectively. Inter-injection agreement for pulmonary right-to-left shunt grade was 0.96 (95% CI 0.93-0.99) and 0.95 (95% CI 0.92-0.98) respectively. There was disagreement in right-to-left shunt grade between the contrast injections in 11 patients (10.3%). Inter-observer variability for presence and grade of the pulmonary right-to-left shunt was 0.95 (95% CI 0.91-0.99) and 0.97 (95% CI 0.95-0.99) respectively.
TTCE has an excellent inter-injection and inter-observer agreement for both the presence and grade of pulmonary right-to-left shunts.
推荐经胸对比超声心动图（TTCE）用于遗传性出血性毛细血管扩张症中肺动静脉畸形（PAVM）的筛查。分流定量用于发现可治疗的PAVM。到目前为止，尚无研究调查该诊断试验的可重复性。因此，本研究旨在描述TTCE的观察者间和注射间变异性。
我们进行了一项前瞻性单中心研究。纳入了2015年所有因遗传性出血性毛细血管扩张症而接受PAVM筛查的连续患者。将每位患者两次对比剂注射的视频分开，并由两位对患者数据不知情的心脏病专家进行评估。肺右向左分流采用三级评分法。采用κ统计量计算肺右向左分流的存在情况和分级的观察者间及注射间一致性。
我们纳入了107例患者（共214次注射）（男性占49.5%，平均年龄45.0±16.6岁）。观察者1和观察者2分别在136次（63.6%）和131次（61.2%）注射中发现肺右向左分流。观察者1和观察者2在肺右向左分流存在情况的注射间一致性分别为0.96（95%置信区间（CI）0.9 - 1.0）和0.98（95%CI 0.94 - 1.00）。肺右向左分流分级的注射间一致性分别为0.96（95%CI 0.93 - 0.99）和0.95（95%CI 0.92 - 0.98）。11例患者（10.3%）的两次对比剂注射在右向左分流分级上存在分歧。肺右向左分流存在情况和分级的观察者间变异性分别为0.95（95%CI 0.91 - 0.99）和0.97（95%CI 0.95 - 0.99）。
TTCE在肺右向左分流的存在情况和分级方面，注射间及观察者间一致性均极佳。
