What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Left ventricular diastolic dysfunction (n=40). Intervention: Image acquisition and reading process (2D vs 3D LAV max). Primary outcome: Variability related to image acquisition and reading process for echocardiographic measures of LV diastolic function.

What does this research mean for the field?

Image acquisition contributes more to the variability of left ventricular diastolic function measures than image reading, and using 3D rather than 2D left atrial volume measurements improves the reliability of diastolic dysfunction classification. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 6, 2021Open Access

Variability of echocardiographic measures of left ventricular diastolic function. The HUNT study

Key Result

Image acquisition influenced variability of LV diastolic function measures more than reading (24% vs 4% of variance), while 3D LAV max improved classification agreement over 2D (Kappa 0.58 vs 0.42).

Study Design

Type

Cross-Sectional (n=40)

Blinding

Blinded

Structured PICO

What is the variability related to image acquisition and reading process for echocardiographic measures of left ventricular diastolic function?

Population

40 participants, mean age 62 (range 28-88) years, 19 women

Intervention

Echocardiographic examinations twice by different echocardiographers and blinded analyses by four readers (including 2D and 3D LAV max, spectral Doppler, and tissue velocities)

Outcome

Variability and reproducibility measures of echocardiographic measures of left ventricular diastolic functionsurrogate

Image acquisition contributes more to variability in echocardiographic assessment of LV diastolic function than image reading, and 3D left atrial volume measurement improves classification reliability compared to 2D.

Abstract

Abstract Objective Investigate variability related to image acquisition and reading process for echocardiographic measures of left ventricular (LV) diastolic function, and its influence on classification of LV diastolic dysfunction (LVDD). Methods Forty participants (19 women) mean age 62 (28–88) years underwent echocardiographic examinations twice by different echocardiographers and blinded analyses by four readers in a cross‐sectional design. Measurements included quantification of two‐ (2D) and three‐dimensional (3D) recordings of the left atrium (LA) (maximal) volume (LAV max ) and spectral Doppler blood flow and tissue velocities for assessment of LV diastolic function. Variability and reproducibility measures were calculated using variance component analyses and Kappa statistics. Results Image acquisition influenced variability more than image reading (mean 24% and 4% of variance, respectively), but variability from image reading was especially important for 2D LAV max (16% of variance) compared to 4% for 3D LAV max , which was reflected in better agreement for 3D measures. The variability of measures used in classification of LVDD had clinical significance, and agreement across the four raters in classification using current recommendations was only fair (Kappa 0.42), but the agreement improved when using 3D LAV max (Kappa 0.58). Agreement and reliability measures were reported for all measures. Conclusion Performing a new image acquisition influenced variability more than a introducing a new image reader, but there were differences across the different measures. LAV max by 3D is superior to 2D with respect to lower variability. The variability of diastolic measures influences the reliability of LVDD classification, and this should be taken into account in the everyday clinic.