van Spijk Julia N, Junge Hannah K, Eberhardt Christina, Wolf Natalie, Vogt Debora, Zscherpe Paula, Herger Elena, Straub Manon, Schwarzwald Colin C
Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.
J Vet Intern Med. 2025 Jul-Aug;39(4):e70145. doi: 10.1111/jvim.70145.
Echocardiographic evaluation of right heart (RH) size and function in horses is challenging and relies on subjective assessment.
Evaluate inter- and intra-rater agreement of subjective assessment of RH size, RH function, and the presence of pulmonary hypertension (PHT) in horses. Assess subjective RH changes with and without PHT and the influence of observer experience.
Healthy horses (n = 30) and horses with Doppler measurements suggesting the presence or absence of PHT (n = 30 each).
Nine standard echocardiographic recordings were analyzed by experienced (n = 4) and inexperienced (n = 5) observers. RH size, RH function, pulmonary artery (PA) size and distensibility, and the presence of PHT were subjectively assessed as normal, mildly, moderately, or severely changed. Inter- and intra-rater agreement was calculated using percentual agreement (% agree) and kappa (k). Sensitivity and specificity to detect PHT were calculated.
Overall inter-rater agreement in all observers was low with 61% perfect agreement and k of 0.21; it was higher in experienced observers (k = 0.34, 77% agree) than in beginners (k = 0.18, 52% agree). Intra-rater agreement showed % agree > 80% in experienced observers (k = 0.35-0.76) and < 80% in beginners (k = 0.33-0.54). RH size and function were more commonly abnormal in the PHT group, with high specificity but low sensitivity to detect PHT.
Rater agreement of subjective RH assessment was low and influenced by observer experience. Subjective absence of RH changes does not allow ruling out PHT, while the presence of characteristic RH changes suggests PHT.
对马的右心（RH）大小和功能进行超声心动图评估具有挑战性，且依赖主观评估。
评估马的RH大小、RH功能以及肺动脉高压（PHT）存在情况的主观评估在不同评估者之间和同一评估者内部的一致性。评估有无PHT时的主观RH变化以及观察者经验的影响。
健康马（n = 30）以及经多普勒测量提示存在或不存在PHT的马（各n = 30）。
由经验丰富的观察者（n = 4）和经验不足的观察者（n = 5）分析9份标准超声心动图记录。主观评估RH大小、RH功能、肺动脉（PA）大小和扩张性以及PHT的存在情况，分为正常、轻度、中度或重度改变。使用百分比一致性（%agree）和kappa（k）计算评估者间和评估者内的一致性。计算检测PHT的敏感性和特异性。
所有观察者的总体评估者间一致性较低，完全一致性为61%，k为0.21；经验丰富的观察者一致性较高（k = 0.34，77%一致），高于初学者（k = 0.18，52%一致）。评估者内一致性显示，经验丰富的观察者%agree > 80%（k = 0.35 - 0.76），初学者< 80%（k = 0.33 - 0.54）。PHT组中RH大小和功能更常出现异常，检测PHT时特异性高但敏感性低。
RH主观评估的评估者一致性较低，且受观察者经验影响。主观上RH无变化不能排除PHT，而出现特征性的RH变化提示PHT。
