Tufts Medical Center, Department of Anesthesiology and Perioperative Medicine, Boston, MA.
Tufts Medical Center, Department of Anesthesiology and Perioperative Medicine, Boston, MA; Mount Sinai Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, New York, NY; University of Washington Medical Center, Department of Anesthesiology and Pain Medicine, Seattle, WA; Amador Valley High School, Pleasanton, CA.
J Cardiothorac Vasc Anesth. 2022 Sep;36(9):3501-3508. doi: 10.1053/j.jvca.2022.03.025. Epub 2022 Mar 27.
The primary aim of this study was to assess interobserver variability in grading tricuspid regurgitation (TR) severity. The authors' secondary goals were to delineate which transesophageal echocardiographic (TEE) parameters best correlate with severity and how consistent the participants were at grading severity.
This was a prospective cohort study of how clinicians evaluated previously acquired TEE images and videos.
The 19 TEE studies of patients with TR were recorded by 4 senior echocardiographers across 4 US academic institutions. The participants evaluated these cases on a novel, web-based, assessment environment designed specifically for this study.
Twenty-nine fellowship-trained and board-certified cardiologists and cardiothoracic anesthesiologists volunteered to participate in the study as observers from 19 different institutions.
No interventions were performed on the participants.
For each case, participants measured the vena contracta (VC), proximal isovelocity surface area (PISA), and jet area before giving a final classification on the severity of TR. Variation was highest for effective regurgitant orifice area and lowest for VC and PISA. The coefficient of variation, defined as the standard deviation from the mean divided by the mean, for all cases of trace, mild, moderate and severe TR were as follows: Jet Area-111%, 46%, 48%, 76%; VC-67%, 44%, 43%, 36%; PISA-52%, 48%, 31%, 35%; and effective regurgitant orifice area-127%, 95%, 66%, 58%.
The interobserver variation in quantifying TEE parameters for TR is high, suggesting these may be difficult to measure reliably in a busy perioperative setting. Of the parameters assessed, VC and PISA radius had the highest interobserver agreement and the highest correlation with severity.
本研究的主要目的是评估三尖瓣反流（TR）严重程度分级的观察者间变异性。作者的次要目标是确定哪些经食管超声心动图（TEE）参数与严重程度相关性最好，以及参与者在分级严重程度方面的一致性如何。
这是一项前瞻性队列研究，研究了临床医生如何评估先前获得的 TEE 图像和视频。
19 例 TR 患者的 TEE 研究由 4 名美国 4 家学术机构的资深超声心动图医师记录。参与者在一个专门为此研究设计的新型基于网络的评估环境中评估这些病例。
29 名来自 19 个不同机构的接受过 fellowship培训和董事会认证的心脏病专家和心胸麻醉师自愿作为观察者参与研究。
对参与者未进行任何干预。
对于每个病例，参与者在对 TR 严重程度进行最终分类之前测量了收缩期瓣口（VC）、近端等速表面积（PISA）和射流面积。有效反流口面积的变化最大，而 VC 和 PISA 的变化最小。所有微量、轻度、中度和重度 TR 病例的变异系数（定义为标准差除以平均值）如下：射流面积-111%、46%、48%、76%；VC-67%、44%、43%、36%；PISA-52%、48%、31%、35%；有效反流口面积-127%、95%、66%、58%。
定量评估 TR 的 TEE 参数的观察者间变异性很高，表明在繁忙的围手术期环境中，这些参数可能难以可靠地测量。在所评估的参数中，VC 和 PISA 半径具有最高的观察者间一致性和与严重程度的最高相关性。
