Francesco Ferrara1, Luna Gargani2, Carla Contaldi1, Gergely Agoston3, Paola Argiento4, William F Armstrong5, Francesco Bandera6,7, Filippo Cademartiri8, Rodolfo Citro1, Antonio Cittadini9, Rosangela Cocchia10, Michele D'Alto4, Antonello D'Andrea11, Philipp Douschan12, Stefano Ghio13, Ekkehard Grünig14, Marco Guazzi6,7, Stefania Guida13, Jaroslaw D Kasprzak15, Theodore John Kolias5, Giuseppe Limongelli4, Alberto Maria Marra9, Matteo Mazzola2, Ciro Mauro10, Antonella Moreo16, Francesco Pieri17, Lorenza Pratali2, Nicola Riccardo Pugliese18, Mauro Raciti2, Brigida Ranieri8, Lawrence Rudski19, Rajan Saggar20, Andrea Salzano8, Walter Serra21, Anna Agnese Stanziola22, Mani Vannan23, Damien Voilliot24, Olga Vriz25, Karina Wierzbowska-Drabik15, Robert Naeije26, Eduardo Bossone27. 1. Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. 2. Institute of Clinical Physiology, C.N.R, Pisa, Italy. 3. Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary. 4. Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy. 5. Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA. 6. Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy. 7. Department for Biomedical Sciences for Health, University of Milano, Milan, Italy. 8. IRCCS SDN, Naples, Italy. 9. Department of Translational Medical Sciences, Federico II University, Naples, Italy. 10. Cardiology Division, A Cardarelli Hospital, Naples, Italy. 11. Division of Cardiology, Umberto I° Hospital Nocera Inferiore, Nocera Inferiore, Italy. 12. Medical University of Graz, Graz, Austria and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria. 13. Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 14. Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany. 15. I Dept. and Chair of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland. 16. A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 17. Cardiology Department, Careggi University Hospital, Florence, Italy. 18. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 19. Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 20. Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs David Geffen School of Medicine, UCLA, Los Angeles, USA. 21. Cardiology Division, University Hospital, Parma, Italy. 22. Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy. 23. Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta, USA. 24. Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France. 25. Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 26. Free University of Brussels, Brussels, Belgium. 27. Cardiology Division, A Cardarelli Hospital, Naples, Italy. ebossone@hotmail.com.
Abstract
PURPOSE: This study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. METHODS: All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S'), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e') and left ventricular ejection fraction (LVEF) were measured. RESULTS: The accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was > 0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e' = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S' = 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. CONCLUSIONS: When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.
PURPOSE: This study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. METHODS: All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S'), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e') and left ventricular ejection fraction (LVEF) were measured. RESULTS: The accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was > 0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e' = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S' = 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. CONCLUSIONS: When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.
Entities:
Keywords:
Exercise echocardiography; Pulmonary hypertension; Right ventricle
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