Bo Remenyi1,2, Jonathan Carapetis3, John W Stirling4, Beatrice Ferreira5, Krishnan Kumar6, John Lawrenson7,8, Eloi Marijon9, Mariana Mirabel10, A O Mocumbi11, Cleonice Mota12, John Paar13, Anita Saxena14, Janet Scheel15, Satu Viali16, I B Vijayalakshmi17, Gavin R Wheaton18, Liesl Zuhlke19, Karishma Sidhu2, Eliazar Dimalapang2, Thomas L Gentles20, Nigel J Wilson2,21. 1. Menzies School of Health Research, Casuarina, Northern Territory, Australia. 2. Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand. 3. Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia. 4. Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand. 5. Maputo HeartInstitute, Maputo, Mozambique. 6. Amrita Institute of Medical Sciences and Research Centre, Kochi, India. 7. Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa. 8. Department of Paediatrics and Child Health, Cape Town, South Africa. 9. Hop Europeen Georges Pompidou, Paris, France. 10. INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France. 11. Inst Coracao, New York City, New York, USA. 12. Federal University of Minas Gerais, Belo Horizonte, Brazil. 13. Cardiology, Project Health for León, Raleigh, North Carolina, USA. 14. All India Institute of Medical Sciences, New Delhi, India. 15. Pediatric Cardiology, Children's National Health System, Washington, District of Columbia, USA. 16. Cardiology, Samoa National Hospital, Apia, Samoa. 17. Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. 18. Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia. 19. Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. 20. Paediatric and Congenital Cardiology, Starship Children's Hospital, Auckland, New Zealand. 21. University of Auckland, Auckland, New Zealand.
Abstract
OBJECTIVE: Different definitions have been used for screening for rheumatic heart disease (RHD). This led to the development of the 2012 evidence-based World Heart Federation (WHF) echocardiographic criteria. The objective of this study is to determine the intra-rater and inter-rater reliability and agreement in differentiating no RHD from mild RHD using the WHF echocardiographic criteria. METHODS: A standard set of 200 echocardiograms was collated from prior population-based surveys and uploaded for blinded web-based reporting. Fifteen international cardiologists reported on and categorised each echocardiogram as no RHD, borderline or definite RHD. Intra-rater and inter-rater reliability was calculated using Cohen's and Fleiss' free-marginal multirater kappa (κ) statistics, respectively. Agreement assessment was expressed as percentages. Subanalyses assessed reproducibility and agreement parameters in detecting individual components of WHF criteria. RESULTS: Sample size from a statistical standpoint was 3000, based on repeated reporting of the 200 studies. The inter-rater and intra-rater reliability of diagnosing definite RHD was substantial with a kappa of 0.65 and 0.69, respectively. The diagnosis of pathological mitral and aortic regurgitation was reliable and almost perfect, kappa of 0.79 and 0.86, respectively. Agreement for morphological changes of RHD was variable ranging from 0.54 to 0.93 κ. CONCLUSIONS: The WHF echocardiographic criteria enable reproducible categorisation of echocardiograms as definite RHD versus no or borderline RHD and hence it would be a suitable tool for screening and monitoring disease progression. The study highlights the strengths and limitations of the WHF echo criteria and provides a platform for future revisions.
OBJECTIVE: Different definitions have been used for screening for rheumatic heart disease (RHD). This led to the development of the 2012 evidence-based World Heart Federation (WHF) echocardiographic criteria. The objective of this study is to determine the intra-rater and inter-rater reliability and agreement in differentiating no RHD from mild RHD using the WHF echocardiographic criteria. METHODS: A standard set of 200 echocardiograms was collated from prior population-based surveys and uploaded for blinded web-based reporting. Fifteen international cardiologists reported on and categorised each echocardiogram as no RHD, borderline or definite RHD. Intra-rater and inter-rater reliability was calculated using Cohen's and Fleiss' free-marginal multirater kappa (κ) statistics, respectively. Agreement assessment was expressed as percentages. Subanalyses assessed reproducibility and agreement parameters in detecting individual components of WHF criteria. RESULTS: Sample size from a statistical standpoint was 3000, based on repeated reporting of the 200 studies. The inter-rater and intra-rater reliability of diagnosing definite RHD was substantial with a kappa of 0.65 and 0.69, respectively. The diagnosis of pathological mitral and aortic regurgitation was reliable and almost perfect, kappa of 0.79 and 0.86, respectively. Agreement for morphological changes of RHD was variable ranging from 0.54 to 0.93 κ. CONCLUSIONS: The WHF echocardiographic criteria enable reproducible categorisation of echocardiograms as definite RHD versus no or borderline RHD and hence it would be a suitable tool for screening and monitoring disease progression. The study highlights the strengths and limitations of the WHF echo criteria and provides a platform for future revisions.
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Authors: Rachel H Webb; Nigel J Wilson; Diana R Lennon; Elizabeth M Wilson; Ross W Nicholson; Tom L Gentles; Clare P O'Donnell; John W Stirling; Irene Zeng; Adrian A Trenholme Journal: Cardiol Young Date: 2011-03-31 Impact factor: 1.093
Authors: Joshua Reginald Francis; Helen Fairhurst; Gillian Whalley; Alex Kaethner; Anna Ralph; Jennifer Yan; James Cush; Vicki Wade; Andre Monteiro; Bo Remenyi Journal: BMJ Open Date: 2020-05-27 Impact factor: 2.692