A quality control exercise in the echo laboratory: Reduction in inter‐observer variability in the interpretation of pulmonary hypertension

Patton, Daniel M.; Enzevaie, Atoosa; Day, Andrew G.; Sanfilippo, Anthony J.; Johri, Amer M.

doi:10.1111/echo.13712

Cited by 4 publications

(3 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Before any acquisition of pooling echocardiographic data for research and clinical applications, a process of quality control and reading harmonization measurements should be undertaken [13][14][15][16]. The present results demonstrate that a rigorously designed protocol with a strong focus on quality assurance and certification can yield very strong ICC and limited variability among the 19 participant experienced centers to a large prospective EDE study of the right heart and the pulmonary circulation.…”

Section: Discussionmentioning

confidence: 76%

A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET)

Ferrara

Gargani

Contaldi

et al. 2021

Cardiovasc Ultrasound

View full text Add to dashboard Cite

Purpose This study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. Methods All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S’), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e’) and left ventricular ejection fraction (LVEF) were measured. Results The accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was > 0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S’ = 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. Conclusions When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.

show abstract

Section: Discussionmentioning

confidence: 76%

A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET)

Ferrara

Gargani

Contaldi

et al. 2021

Cardiovasc Ultrasound

View full text Add to dashboard Cite

show abstract

“…Before any acquisition of pooling echocardiographic data for research and clinical applications, a process of quality control and reading harmonization measurements should be undertaken. [13][14][15][16] The present results demonstrate that a rigoroursly designed protocol with a strong focus on quality assurance and certification can yield very strong ICC and limited variability among the 19 participant experienced centers to a large prospective EDE study of the right heart and the pulmonary circulation.…”

Section: Discussionmentioning

confidence: 64%

A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation

Ferrara¹,

Gargani²,

Contaldi³

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: This study was a quality-control study of resting and exercise echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. Methods: All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S'), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e') and left ventricular ejection fraction (LVEF) was measured. Results: The accuracy of 19 investigators for all variables ranged from 99.7% to 100%. ICC was > 0.80 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e' = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S'= 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. Conclusions: When performed in expert centers EDE is a reproducible tool for the assessment

show abstract

“…Pre vs. post comparisons of echocardiographic parameters were performed using paired t-tests or paired Wilcoxon signed-rank tests as appropriate. An increase in RVSP after AVF creation was defined as an increment > 3 mmHg compared to the baseline value, given the inter-observer variability range reported by Patton et al [ 39 ] in trained personnel. Similarly, a decrease in RVSP was defined as a reduction by more than 3 mmHg, while post-AVF values within 3 mmHg of baseline measurements were considered “stable”.…”

Section: Methodsmentioning

confidence: 99%

Echocardiographic changes after arteriovenous fistula creation in hemodialysis patients

Manzur-Pineda¹,

Martinez²,

Alvarez³

et al. 2022

View full text Add to dashboard Cite

Background: Pulmonary hypertension (PH) is common in end-stage renal disease (ESRD) patients and is associated with increased all-cause and cardiovascular mortality in this group. There is scarce data on the long-term effect of arteriovenous fistula (AVF) creation on pulmonary hypertension (PH) and the reflected changes in echocardiographic measurements. Materials and methods: This is a retrospective study of 54 patients who underwent AVF creation between 2009 and 2014 and with echocardiographic evaluations before and after surgery. We analyzed pairwise changes in right ventricular systolic pressure (RVSP), right atrial pressure (RAP) during systole, left ventricular mass (LVM), tricuspid regurgitation (TR), mitral E/E’ ratio, and ejection fraction (EF), as well as the factors that predicted change in RVSP after surgery. Results: The median time for the preoperative echocardiogram was 0.3 years (interquartile range (IQR) 0.2 – 0.7 years) prior to AVF creation, while the follow-up echo was done 1.3 (0.6 – 2.1) years after surgery. 67% of the patients had RVSP > 37 mmHg at baseline. There was a significant reduction in RVSP after AVF creation compared to baseline (median 33 (IQR 26 – 43) vs. 46 mmHg, p = 0.0015), with 59% of the patients experiencing a decrease and 19% remaining stable. There were also significant decreases in LVM (201 (143 – 256) vs. 215 (163 – 276), p = 0.045) and RAP systole (10 (10 – 15) vs. 3 (3 – 8); p < 0.001) after surgery. Higher preoperative weight (p = 0.038) and RVSP (p = 0.006), and use of loop diuretics (p = 0.015) were significantly associated with improvement in RVSP after AVF creation. Conclusion: Our results suggest that AVF creation is associated with a significant reduction or stable measurements of RVSP in the ESRD population, likely due to an improvement in volume status.

show abstract

A quality control exercise in the echo laboratory: Reduction in inter‐observer variability in the interpretation of pulmonary hypertension

Abstract: A simple structured teaching intervention successfully reduced IOV in the measurement of RVSP in a high-volume echo laboratory.

Cited by 4 publications

References 10 publications

A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET)

A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET)

A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation

Echocardiographic changes after arteriovenous fistula creation in hemodialysis patients

Contact Info

Product

Resources

About