Reproducibility in Echocardiographic Assessment of Diastolic Function in a Population Based Study (The STANISLAS Cohort Study)

Abstract

IntroductionThere is limited evidence regarding intra-observer and inter-observer variations in echocardiographic measurements of diastolic function. This study aimed to assess this reproducibly within a population-based cohort study.MethodsSixty subjects in sinus rhythm were randomly selected among 4th visit participants of the STANISLAS Cohort (Lorraine region, France). This 4th examination systematically included M-mode, 2-dimensional, DTI and pulsed-wave Doppler echocardiograms. Reproducibility of variables was studied by intra-class correlation coefficients (ICC) and Bland Altman plots.ResultsOur population was on average middle-aged (50 ± 14y), overweight (BMI = 26 ± 6kg/m2) and non-smoking (87%) with a quarter of the participants having self-declared hypertension or treated with anti-hypertensive medication(s). Intra-observer ICC were > 0.90 for all analyzed parameters except for left ventricular ejection fraction (LVEF) which was 0.89 (0.81–0.93). The mean relative intra-observer differences were small and limits of agreement of relative differences were narrow for all considered parameters (<5% and <15% respectively). Inter-observer ICC were > 0.90 for all analyzed parameters except for LVEF (ICC = 0.87) and both mitral and pulmonary A wave duration (0.83 and 0.73 respectively). The mean relative inter-observer differences were <5% for all parameters except for pulmonary A wave duration (mean difference = 6.5%). Limits of agreement of relative differences were narrow (<15%), except for mitral A wave duration and velocity (both <20%) as well as left ventricular mass and pulmonary A wave duration (both <30%). Intra-observer agreements with regard to the presence and severity of diastolic dysfunction were excellent (Kappa = 0.93 (0.83–1.00) and 0.88 (0.75–0.99), respectively).ConclusionIn this validation study within the STANISLAS cohort, diastolic function echocardiographic parameters were found to be highly reproducible. Diastolic dysfunction consequently appears as a highly effective clinical and research tool.

Assessment of diastolic function and atrial remodeling by MRI - validation and correlation with echocardiography and filling pressure

“…For example, Leng et al (2015) obtained strong agreement when validating e 0 by MRI to TTE, as did this study which used a freely available image analysis tool. Furthermore, interobserver and intraobserver variability in the proposed method for e 0 quantification were in parity with reported repeatability in echocardiography (Frikha et al 2015). Taken together, this shows that MRI-calculated e 0 is well-correlated with TTE and reproducible.…”

“…Furthermore, interobserver and intraobserver variability in the proposed method for e′ quantification were in parity with reported repeatability in echocardiography (Frikha et al. ). Taken together, this shows that MRI‐calculated e′ is well‐correlated with TTE and reproducible.…”

A Practical Guide to Assess the Reproducibility of Echocardiographic Measurements

“…Repeatability coefficients and the coefficient of variation are commonly used and can be calculated without difficulty. 7 For assessment of within-subject variation, three repeat measurements are usually considered appropriate, 7,45 translated into echocardiography as the average of three Doppler indices. This is probably appropriate for sinus rhythm, but in the case of atrial fibrillation, the assessment of reproducibility is even more challenging because of the variation in ejection time and volume between consecutive heart beats.…”

Reproducibility in Echotracking Assessment of Local Carotid Stiffness, Diameter and Thickness in a Population-based Study (The STANISLAS Cohort Study)

“…Our study protocol included four phases, namely (1) the comparison of the measurements derived from the WTS and ART.LAB systems, (2) the devices' internal reproducibility analysis, (3) the inter-observer reproducibility analysis and (4) intra-observer reproducibility. For the first and second phase of the study protocol, both IMT measurements were performed in 188 consecutive participants from the fourth examination of the STANISLAS Cohort (Clinical Trial: NCT01391442) [16][17][18] by a senior imaging engineer (as the goal of this phase was to provide an optimal comparison of the results provided by the two devices). For the third phase of the protocol, 60 participants were consecutively included across three ongoing cohorts simultaneously conducted in our centre, in whom measurements were successively performed by three operators (one senior engineer and two research nurses).…”