Defining the real-world reproducibility of visual grading and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation.
Author(s)
Type
Journal Article
Abstract
Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1–20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an “eyeball” EF estimate and (3) an image quality rating on a 0–100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator’s chance of agreement with another operator was 50 % and with themself on blinded re-presentation was 68 %. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators’ assessments, correlated with EF estimate variability (r = −0.616, p < 0.01) and visual grading agreement (r = 0.58, p < 0.01). However, operators’ own single quality assessments were not a useful forewarning of their estimate being an outlier, partly because individual quality assessments had poor within-operator reproducibility (SD of difference 17.8). Reproducibility of visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.
Date Issued
2015-07-04
Date Acceptance
2015-04-08
Citation
International Journal of Cardiovascular Imaging, 2015, 31 (7), pp.1303-1314
ISSN
1569-5794
Publisher
Springer Verlag
Start Page
1303
End Page
1314
Journal / Book Title
International Journal of Cardiovascular Imaging
Volume
31
Issue
7
Copyright Statement
© 2015 The Authors. This article is published with open access at SpringerLink.com. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
License URL
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
Grant Number
RD410
FS/10/38/28268
FS/12/12/29294
FS/14/13/30619
FS/14/27/30752
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Radiology, Nuclear Medicine & Medical Imaging
Cardiovascular System & Cardiology
Echocardiography
Ventricular function
Heart failure
Reproducibility of results
CARDIAC RESYNCHRONIZATION THERAPY
INTRACARDIAC FILLING PRESSURE
SYSTOLIC HEART-FAILURE
DECOMPENSATED PATIENTS
ATRIOVENTRICULAR OPTIMIZATION
ITERATIVE METHOD
ECHOCARDIOGRAPHY
ANGIOGRAPHY
BEHOLDER
ARTICLE
Accreditation
Adult
Aged
Clinical Competence
Female
Humans
Male
Middle Aged
Observer Variation
Predictive Value of Tests
Reproducibility of Results
Severity of Illness Index
Stroke Volume
Ventricular Dysfunction, Left
Ventricular Function, Left
Visual Perception
1102 Cardiovascular Medicine And Haematology
Nuclear Medicine & Medical Imaging
Publication Status
Published