An automated decision support algorithm for evaluating left ventricular diastolic function had poor agreement with manual assessments, underscoring the need for standardized evaluation tools.
Observational (n=20)
Does an automated decision support algorithm improve the standardization and reduce variability in the echocardiographic assessment of left ventricular diastolic function compared to manual assessment?
An automated decision support tool for evaluating left ventricular diastolic function highlights significant inter-rater variability in manual assessments and offers a standardized, guidelines-based alternative.
Echocardiographic assessment of the left ventricular diastolic function (LVDF), an integrated part of evaluation of left ventricular function is still a delicate task and is performed with substantial inter-rater variability. Therefore, we aimed to create and evaluate a guidelines-based automated decision support. An algorithm was created for a hierarchical analysis of LVDF based on variables as recommended by the latest guidelines. Age-adjusted normal ranges were pooled from previously published studies into an integrated reference table. For proof-of-concept, 20 echocardiographic examinations were analyzed offline by four experienced physicians with more than 10 years of echocardiographic experience. The first assessments were to be performed as they would be in the clinical practice. Six months later, the assessments were repeated based on the 2017 ASE/EACVI guidelines. The overall inter-rater agreement for the first clinical assessments was moderate, while the guidelines-based assessments had only fair inter-rater agreement. Both kinds of manual assessment had poor agreement with the standardized automated assessment algorithm of LVDF. In conclusion, the presented automated decision support for evaluation of diastolic LV function by Doppler echocardiography is mainly based on current guidelines involving multiple parameters in combination. Incorporating age dependency aspects in our program (available for use at https://liu.se/en/research/left-ventricular-diastolic-function-decision-support) enhances the accuracy of the evaluation and reduces variability in evaluation of LVDF. The large inter-rater variation in classification in this study also underscores the usefulness of tools to support a standardized evaluation.
Tamás et al. (Wed,) conducted a observational in Left ventricular diastolic function assessment (n=20). Automated decision support algorithm vs. Manual assessment (clinical practice and guidelines-based) was evaluated on Inter-rater agreement and agreement with automated algorithm. An automated decision support algorithm for evaluating left ventricular diastolic function had poor agreement with manual assessments, underscoring the need for standardized evaluation tools.