D Balian, B Koethe, S Mohanty, Y Daaboul, S H Mahrokhian, J Frankel, J Li, A Kherlopian, B C Downey, B Wessler
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引用次数: 0
Abstract
Background: Aortic stenosis (AS) is the most common degenerative valve disease in high income countries. While hemodynamic metrics are commonly used to assess severity of stenosis, they are impacted by loading conditions and stroke volume and are often discordant. Anatomic valve assessments such as aortic valve calcification (AVC) and valve motion (VM) during transthoracic echocardiography (TTE) can offer clues to disease severity. The reliability of these semi-quantitatively assessed anatomic imaging parameters is unknown.
Methods: This is a retrospective study of semi-quantitative assessment of AVC and valve VM on TTE. TTEs representing a range of AS severities were identified. The degree of calcification of the aortic valve and the degree of restricted VM were assessed in standard fashion. AVC scores and valve motion were assessed by readers with varied training levels blinded to the severity of AS. Correlation and inter-reader reliability between readers were assessed.
Results: 420 assessments (210 each for AVC and VM) were collected for 35 TTEs. Correlation of AVC for imaging trainees (fellows and students, respectively), ranged from 0.49 (95% CI 0.18-0.70) to 0.62 (95% CI 0.36-0.79) and 0.58 (95% CI 0.30-0.76) to 0.54 (95% CI 0.25-0.74) for VM. Correlation of anatomic assessments between echocardiographer-assigned AVC grades was r = 0.76 (95% CI 0.57-0.87)). The correlation between echocardiographer-assigned assessment of VM was r = 0.73 (95% CI 0.53-0.86), p < 0.00001 for both. For echocardiographer AVC assessment, weighted kappa was 0.52 (0.32-0.72), valve motion weighted kappa was 0.60 (0.42-0.78).
Conclusion: There was good inter-reader correlation between TTE-based semi-quantitative assessment of AVC and VM when assessed by board certified echocardiographers. There was modest inter-reader reliability of semi-quantitative assessments of AVC and VM between board certified echocardiographers. Inter-reader correlation and reliability between imaging trainees was lower. More reliable methods to assess TTE based anatomic assessments are needed in order to accurately track disease progression.
背景：主动脉瓣狭窄（AS）是高收入国家最常见的瓣膜退行性疾病。虽然血液动力学指标通常用于评估瓣膜狭窄的严重程度，但这些指标受负荷条件和每搏容量的影响，而且往往不一致。经胸超声心动图（TTE）中的主动脉瓣钙化（AVC）和瓣膜运动（VM）等瓣膜解剖评估可提供疾病严重程度的线索。这些半定量评估的解剖成像参数的可靠性尚不清楚：这是一项关于 TTE 上 AVC 和瓣膜 VM 半定量评估的回顾性研究。确定了代表一系列 AS 严重程度的 TTE。以标准方式评估主动脉瓣钙化程度和瓣膜VM受限程度。AVC评分和瓣膜运动由受过不同训练的读片者进行评估，他们对AS的严重程度视而不见。对读数者之间的相关性和读数者之间的可靠性进行了评估：对 35 张 TTE 进行了 420 次评估（AVC 和 VM 各 210 次）。成像受训者（分别为研究员和学生）的AVC相关性为0.49（95% CI 0.18-0.70）至0.62（95% CI 0.36-0.79），VM相关性为0.58（95% CI 0.30-0.76）至0.54（95% CI 0.25-0.74）。超声心动图学家分配的 AVC 等级之间的解剖评估相关性为 r = 0.76（95% CI 0.57-0.87））。超声心动图学家指定的 VM 评估之间的相关性为 r = 0.73（95% CI 0.53-0.86），p 结论：由获得认证的超声心动图医师进行基于 TTE 的 AVC 和 VM 半定量评估时，读片者之间具有良好的相关性。获得专业认证的超声心动图医师对 AVC 和 VM 进行半定量评估时，读片者之间的可靠性一般。成像受训者之间的读片者间相关性和可靠性较低。需要更可靠的方法来评估基于 TTE 的解剖评估，以准确跟踪疾病进展：临床试验编号：STUDY00003100。
期刊介绍：
Echo Research and Practice aims to be the premier international journal for physicians, sonographers, nurses and other allied health professionals practising echocardiography and other cardiac imaging modalities. This open-access journal publishes quality clinical and basic research, reviews, videos, education materials and selected high-interest case reports and videos across all echocardiography modalities and disciplines, including paediatrics, anaesthetics, general practice, acute medicine and intensive care. Multi-modality studies primarily featuring the use of cardiac ultrasound in clinical practice, in association with Cardiac Computed Tomography, Cardiovascular Magnetic Resonance or Nuclear Cardiology are of interest. Topics include, but are not limited to: 2D echocardiography 3D echocardiography Comparative imaging techniques – CCT, CMR and Nuclear Cardiology Congenital heart disease, including foetal echocardiography Contrast echocardiography Critical care echocardiography Deformation imaging Doppler echocardiography Interventional echocardiography Intracardiac echocardiography Intraoperative echocardiography Prosthetic valves Stress echocardiography Technical innovations Transoesophageal echocardiography Valve disease.
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