Why the study?
Assessment of left atrial size in dogs informs clinical staging, risk assessment, and prognosis, but the diagnostic performance across different observer experience levels using three techniques needed evaluation.
Does observer experience level and measurement technique affect the accuracy and reliability of echocardiographic left atrial size assessment in dogs?
Does observer experience level and measurement technique affect the accuracy and reliability of echocardiographic left atrial size assessment in dogs?
Echocardiographic assessment of left atrial size in dogs is highly reproducible across experience levels, though diagnostic accuracy improves with experience and is better with LAiAPD than LA:Ao.
Experience level may affect LA measurement reliability in dogs; leaves open optimal technique selection for clinical use.
Assessment of left atrial (LA) sizes in dogs informs clinical staging, risk assessment, treatment decisions, and prognosis. The objective of this study was to assess the diagnostic performance of observers with different levels of experience measuring the LA with three different techniques. Echocardiographic images from 36 dogs with different degrees of left atrial enlargement (LAE) were retrospectively retrieved, anonymized and measured in a blinded fashion by a veterinary student, a first-year cardiology resident, a third-year cardiology resident, and two board-certified veterinary cardiologists. The LA to aortic root ratio (LA:Ao), LA antero-postero diameter indexed to body weight (LAiAPD) and left atrial area were measured. Inter- and intra-observer intraclass correlation coefficients (ICCs) were calculated for all three variables. Bland-Altman plots and accuracy in identification of LAE were calculated for the three least experienced observers using LA:Ao and LAiAPD. Intra- and interobserver ICCs were greater than 0.9 for every variable. The observer with least experience had significant positive bias and a tendency to overestimate larger measurements using LA:Ao, but not using LAiAPD. The accuracy of identification of LAE also increased with the increasing level of experience and was higher for LAiAPD compared to LA:Ao. Combining both methods for identification of LAE, further increased accuracy.
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Safian et al. (2022) studied this question.
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