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Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation

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 c...

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Autores principales: Cole, Graham D., Dhutia, Niti M., Shun-Shin, Matthew J., Willson, Keith, Harrison, James, Raphael, Claire E., Zolgharni, Massoud, Mayet, Jamil, Francis, Darrel P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Netherlands 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572050/
https://www.ncbi.nlm.nih.gov/pubmed/26141526
http://dx.doi.org/10.1007/s10554-015-0659-1
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author Cole, Graham D.
Dhutia, Niti M.
Shun-Shin, Matthew J.
Willson, Keith
Harrison, James
Raphael, Claire E.
Zolgharni, Massoud
Mayet, Jamil
Francis, Darrel P.
author_facet Cole, Graham D.
Dhutia, Niti M.
Shun-Shin, Matthew J.
Willson, Keith
Harrison, James
Raphael, Claire E.
Zolgharni, Massoud
Mayet, Jamil
Francis, Darrel P.
author_sort Cole, Graham D.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10554-015-0659-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-45720502015-09-23 Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation Cole, Graham D. Dhutia, Niti M. Shun-Shin, Matthew J. Willson, Keith Harrison, James Raphael, Claire E. Zolgharni, Massoud Mayet, Jamil Francis, Darrel P. Int J Cardiovasc Imaging Original Paper 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10554-015-0659-1) contains supplementary material, which is available to authorized users. Springer Netherlands 2015-07-04 2015 /pmc/articles/PMC4572050/ /pubmed/26141526 http://dx.doi.org/10.1007/s10554-015-0659-1 Text en © The Author(s) 2015 Open AccessThis 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.
spellingShingle Original Paper
Cole, Graham D.
Dhutia, Niti M.
Shun-Shin, Matthew J.
Willson, Keith
Harrison, James
Raphael, Claire E.
Zolgharni, Massoud
Mayet, Jamil
Francis, Darrel P.
Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
title Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
title_full Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
title_fullStr Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
title_full_unstemmed Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
title_short Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
title_sort defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572050/
https://www.ncbi.nlm.nih.gov/pubmed/26141526
http://dx.doi.org/10.1007/s10554-015-0659-1
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