Interobserver variability in the detection of spontaneous echo contrast, left atrial thrombi, and left atrial appendage thrombi by transoesophageal echocardiography.

Abstract

Interobserver variability in the diagnosis of spontaneous echo contrast is low. Defined criteria decrease interobserver variability for left atrial and appendage thrombi, although one third of the thrombi diagnosed by one observer were not confirmed by the other. Interobserver variability is high in the assessment of small structures (< 15 mm) within the left atrial appendage.

Diagnosis of Left Atrial Appendage Thrombi by Multiplane Transesophageal Echocardiography Interlaboratory Comparative Study

“…[6][7][8][9][10]22 By comparing the results obtained in 2 different echocardiographic laboratories, however, a high interobserver variability has been reported for diagnosing LAAT using mono-or biplane TEE probes. 16,20 In the beginning of the TEE era, pectinate muscles and the ridge between the LAA and the left upper pulmonary vein represented a diagnostic problem because they were mistaken for thrombi. 2,9,[12][13][14][15][16]23 The reported interobserver agreement on LAAT was low, with a kappa value of 0.48 for monoplane probes 16 and 0.63 for biplane probes.…”

“…16,20 In the beginning of the TEE era, pectinate muscles and the ridge between the LAA and the left upper pulmonary vein represented a diagnostic problem because they were mistaken for thrombi. 2,9,[12][13][14][15][16]23 The reported interobserver agreement on LAAT was low, with a kappa value of 0.48 for monoplane probes 16 and 0.63 for biplane probes. 16,20 The introduction of multiplane TEE probes has improved visualization of the LAA and facilitated the diagnosis of pectinate muscles.…”

“…2,9,[12][13][14][15][16]23 The reported interobserver agreement on LAAT was low, with a kappa value of 0.48 for monoplane probes 16 and 0.63 for biplane probes. 16,20 The introduction of multiplane TEE probes has improved visualization of the LAA and facilitated the diagnosis of pectinate muscles. Thus, it was expected that the use of multiplane TEE transducers would decrease the interobserver variability, rendering the diagnosis of LAAT more reliable.…”

“…Both observers used the same criteria for the diagnosis of LAAT: a mass within the LAA cavity with (1) clear borders, (2) echogenicity distinct from the surrounding walls, (3) independent mobility, and (4) visible in 2 orthogonal planes. 16 At least 3 criteria were required for the diagnosis of a definite thrombus. After the results had been obtained separately by each observer, controversial cases were reviewed together in order to clarify the reason for the discrepancy and to eliminate the category of questionable…”

“…[6][7][8][9][10] In the beginning of the TEE era there were problems in differentiating LAAT from pectinate muscles using mono-or biplane probes, [11][12][13][14][15] which resulted in a high interobserver variability. 16,17 Multiplane TEE probes are assumed to improve the diagnosis of LAAT. 18,19 However, there are only limited data on the interobserver variability of different echocardiographic laboratories in diagnosing LAAT, and a thorough evaluation of the reasons for discrepant echocardiographic results has not been reported so far.…”