Echocardiographic assessment of diastolic function using current guidelines yielded discordant results, with a Kappa of 0.20 between Mayo 2003 and ASE 2016, and 0.25 between ASE 2009 and ASE 2016.
Observational (n=200)
Do different echocardiographic algorithms (Mayo 2003, ASE 2009, ASE 2016) yield concordant results in grading diastolic function?
Current guidelines for assessing diastolic function via echocardiography yield discordant results and cannot be reliably applied in over half of patients due to coexisting conditions or poor image quality.
Effect estimate: Kappa 0.20-0.25
OBJECTIVE: We undertook this study of echocardiographic classification of diastolic function by three different algorithms to determine: (1) how frequently each algorithm classified patients and (2) how well the results agreed with one another. BACKGROUND: Several algorithms exist to grade diastolic function (DF), the Mayo Clinic scheme of Redfield et al (Mayo 2003) and the 2 ASE guideline documents of 2009 and 2016 (ASE 2009 and ASE 2016). METHODS: A total of 200 consecutive echocardiograms were retrospectively analyzed; mean age of patients 60.3 ± 3.5 years, 45% male. Echocardiograms were performed using Intersocietal Accreditation Commission guidelines. Diastolic function was assessed by Mayo 2003 and ASE 2009 and 2016. Coexisting conditions affecting DF analysis, such as mitral annular calcification (MAC), were tabulated. Data were compared using a paired t-test. Concordance between algorithms was assessed using the Kappa statistic. RESULTS: A total of 117 of 200 studies (58.5%) were excluded for the presence of coexisting conditions (51.5%), poor image quality (2.5%), or incomplete data (4.5%). Thirty-three of the remaining 83 studies (40%) received the same grade of DF based on assessments made using the Mayo 2003 and ASE 2016 algorithms; the Kappa statistic was 0.20. 36 of the 83 studies (43%) received the same grade of DF based on assessments made using the ASE 2009 and ASE 2016 algorithms; the Kappa statistic was 0.25. CONCLUSION: Assessment of diastolic function via echocardiography cannot be reliably accomplished in approximately 50% of patients using current guidelines. Further, when studies are suitable for assessment, widely used guidelines yield discordant results.
Gottbrecht et al. (Sun,) conducted a observational in Diastolic function (n=200). Diastolic function algorithms (Mayo 2003, ASE 2009, ASE 2016) vs. Comparison between algorithms was evaluated on Concordance between algorithms (Kappa 0.20-0.25). Echocardiographic assessment of diastolic function using current guidelines yielded discordant results, with a Kappa of 0.20 between Mayo 2003 and ASE 2016, and 0.25 between ASE 2009 and ASE 2016.
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