Kenya Kusunose1, Kentaro Shibayama2, Hiroyuki Iwano3, Masaki Izumo4, Nobuyuki Kagiyama5, Koji Kurosawa6, Hirotsugu Mihara7, Hiroki Oe8, Tetsuari Onishi9, Toshinari Onishi10, Mitsuhiko Ota11, Shunsuke Sasaki12, Yumi Shiina13, Hikaru Tsuruta14, Hidekazu Tanaka15. 1. Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan. Electronic address: kusunosek@tokushima-u.ac.jp. 2. Heart Center, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan. 3. Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan. 4. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. 5. Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 6. Department of Clinical Laboratory Center, Gunma University Hospital, Maebashi, Japan. 7. Department of Cardiovascular Medicine, Yokkaichi Municipal Hospital, Yokkaichi, Japan. 8. Center of Ultrasonic Diagnostics, Okayama University Hospital, Okayama, Japan. 9. Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan. 10. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 11. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 12. Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan. 13. Division of Cardiovascular Centre, St. Luke's International Hospital, Tokyo, Japan. 14. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 15. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Abstract
BACKGROUND: Visual estimation of left ventricular ejection fraction (LVEF) is widely applied to confirm quantitative EF. However, visual assessment is subjective, and variability may be influenced by observer experience. We hypothesized that a learning session might reduce the misclassification rate. METHODS: Protocol 1: Visual LVEFs for 30 cases were measured by 79 readers from 13 cardiovascular tertiary care centers. Readers were divided into 3 groups by their experience: limited (1-5 years, n=28), intermediate (6-11 years, n=26), and highly experienced (12-years, n=25). Protocol 2: All readers were randomized to assess the effect of a learning session with reference images only or feedback plus reference images. After the session, 20 new cases were shown to all readers following the same methodology. To assess the concordance and accuracy pre- and post-intervention, each visual LVEF measurement was compared to overall average values as a reference. RESULTS: Experience affected the concordance in visual EF values among the readers. Groups with intermediate and high experience showed significantly better mean difference (MD), standard deviation (SD), and coefficient of variation (CV) than those with limited experience at baseline. The learning session with reference image reduced the MD, SD, and CV in readers with limited experience. The learning session with reference images plus feedback also reduced proportional bias. Importantly, the misclassification rate for mid-range EF cases was reduced regardless of experience. CONCLUSION: This large multicenter study suggested that a simple learning session with reference images can successfully reduce the misclassification rate for LVEF assessment.
BACKGROUND: Visual estimation of left ventricular ejection fraction (LVEF) is widely applied to confirm quantitative EF. However, visual assessment is subjective, and variability may be influenced by observer experience. We hypothesized that a learning session might reduce the misclassification rate. METHODS: Protocol 1: Visual LVEFs for 30 cases were measured by 79 readers from 13 cardiovascular tertiary care centers. Readers were divided into 3 groups by their experience: limited (1-5 years, n=28), intermediate (6-11 years, n=26), and highly experienced (12-years, n=25). Protocol 2: All readers were randomized to assess the effect of a learning session with reference images only or feedback plus reference images. After the session, 20 new cases were shown to all readers following the same methodology. To assess the concordance and accuracy pre- and post-intervention, each visual LVEF measurement was compared to overall average values as a reference. RESULTS: Experience affected the concordance in visual EF values among the readers. Groups with intermediate and high experience showed significantly better mean difference (MD), standard deviation (SD), and coefficient of variation (CV) than those with limited experience at baseline. The learning session with reference image reduced the MD, SD, and CV in readers with limited experience. The learning session with reference images plus feedback also reduced proportional bias. Importantly, the misclassification rate for mid-range EF cases was reduced regardless of experience. CONCLUSION: This large multicenter study suggested that a simple learning session with reference images can successfully reduce the misclassification rate for LVEF assessment.
Authors: Christina Luong; Zhibin Liao; Amir Abdi; Purang Abolmaesumi; Teresa S M Tsang; Hany Girgis; Robert Rohling; Kenneth Gin; John Jue; Darwin Yeung; Elena Szefer; Darby Thompson; Michael Yin-Cheung Tsang; Pui Kee Lee; Parvathy Nair Journal: Int J Cardiovasc Imaging Date: 2020-11-19 Impact factor: 2.357
Authors: Federico M Asch; Nicolas Poilvert; Theodore Abraham; Madeline Jankowski; Jayne Cleve; Michael Adams; Nathanael Romano; Ha Hong; Victor Mor-Avi; Randolph P Martin; Roberto M Lang Journal: Circ Cardiovasc Imaging Date: 2019-09-16 Impact factor: 7.792