Sherif F Nagueh1, Theodore P Abraham2,3, Gerard P Aurigemma, Jeroen J Bax4, Carmen Beladan5, Alyssa Browning3, Mohammed A Chamsi-Pasha1, Victoria Delgado4, Genevieve Derumeaux6, Giulia Dolci4, Erwan Donal7, Thor Edvardsen8, Kinan Carlos El Tallawi1, Laura Ernande6, Roberta Esposito9, Frank A Flachskampf10, Maurizio Galderisi9, James Gentry11, Steven A Goldstein12, Serge C Harb11, Arnaud Hubert7, Judy Hung13, Allan L Klein11, Patrizio Lancellotti14, Redah Z Mahmood12, Paolo Marino15, Bogdan A Popescu5, Martina Previato6, Saket R Sanghai2, Otto A Smiseth8, Jiaqiong Xu1. 1. Methodist DeBakey Heart and Vascular Center, Center for Outcomes Research, Houston Methodist Research Institute, TX (S.F.N., M.A.C.-p., K.C.E.t., J.X.). 2. Department of Medicine, University of Massachusetts Medical School, Worcester (G.P.A., S.R.S.). 3. Division of Cardiology, University of California at San Francisco (T.P.A., A.B.). 4. Department of Cardiology, Leiden University Medical Center, the Netherlands (J.J.B., V.D., G. Dolci). 5. University of Medicine and Pharmacy "Carol Davila," Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania (C.B., B.A.P.). 6. Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France (G. Derumeaux, L.E., M.P.). 7. Service de Cardiologie et Maladies Vasculaires, LTSI INSERM 1099, Universite Rennes-1, CHU Rennes, France (E.D., A.H.). 8. University of Oslo, Norway (T.E., O.A.S.). 9. Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy (R.E., M.G.). 10. Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala, Sweden (F.A.F.). 11. Cleveland Clinic, OH (J.G., S.C.H., A.L.K.). 12. Department of Cardiology, MedStar Heart and Vascular Institute, Washington, DC (S.A.G., R.Z.M.). 13. Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.). 14. University of Liège Hospital, Belgium (P.L.). 15. Universita Piemonte Orientale, Novara, Italy (P.M.).
Abstract
BACKGROUND: Assessment of left ventricular (LV) filling pressure is among the important components of a comprehensive echocardiographic report. Previous studies noted wide limits of agreement using 2009 American Society of Echocardiography/European Association of Echocardiography guidelines, but reproducibility of 2016 guidelines update in estimating LV filling pressure is unknown. METHODS: Echocardiographic and hemodynamic data were obtained from 50 patients undergoing cardiac catheterization for clinical indications. Clinical and echocardiographic findings but not invasive hemodynamics were provided to 4 groups of observers, including experienced echocardiographers and cardiology fellows. Invasively acquired LV filling pressure was the gold standard. RESULTS: In group I of 8 experienced echocardiographers from the guidelines writing committee, sensitivity for elevated LV filling pressure was 92% for all observers, and specificity was 93±6%. Fleiss κ-value for the agreement in group I was 0.80. In group II of 4 fellows in training, sensitivity was 91±2%, and specificity was 95±2%. Fleiss κ-value for the agreement in group II was 0.94. In group III of 9 experienced echocardiographers who had not participated in drafting the guidelines, sensitivity was 88±5%, and specificity was 91±7%. Fleiss κ-value for the agreement in group III was 0.76. In group IV of 7 other fellows, sensitivity was 91±3%, and specificity was 92±5%. Fleiss κ-value for the agreement in group IV was 0.89. CONCLUSIONS: There is a good level of agreement and accuracy in the estimation of LV filling pressure using the American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 recommendations update, irrespective of the experience level of the observer.
BACKGROUND: Assessment of left ventricular (LV) filling pressure is among the important components of a comprehensive echocardiographic report. Previous studies noted wide limits of agreement using 2009 American Society of Echocardiography/European Association of Echocardiography guidelines, but reproducibility of 2016 guidelines update in estimating LV filling pressure is unknown. METHODS: Echocardiographic and hemodynamic data were obtained from 50 patients undergoing cardiac catheterization for clinical indications. Clinical and echocardiographic findings but not invasive hemodynamics were provided to 4 groups of observers, including experienced echocardiographers and cardiology fellows. Invasively acquired LV filling pressure was the gold standard. RESULTS: In group I of 8 experienced echocardiographers from the guidelines writing committee, sensitivity for elevated LV filling pressure was 92% for all observers, and specificity was 93±6%. Fleiss κ-value for the agreement in group I was 0.80. In group II of 4 fellows in training, sensitivity was 91±2%, and specificity was 95±2%. Fleiss κ-value for the agreement in group II was 0.94. In group III of 9 experienced echocardiographers who had not participated in drafting the guidelines, sensitivity was 88±5%, and specificity was 91±7%. Fleiss κ-value for the agreement in group III was 0.76. In group IV of 7 other fellows, sensitivity was 91±3%, and specificity was 92±5%. Fleiss κ-value for the agreement in group IV was 0.89. CONCLUSIONS: There is a good level of agreement and accuracy in the estimation of LV filling pressure using the American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 recommendations update, irrespective of the experience level of the observer.
Authors: Luis E Echeverría; Sergio Alejandro Gómez-Ochoa; Lyda Z Rojas; Karen Andrea García-Rueda; Pedro López-Aldana; Taulant Muka; Carlos A Morillo Journal: Front Cardiovasc Med Date: 2021-11-29
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