Valvular heart diseaseDevelopment of a Consensus Document to Improve Multireader Concordance and Accuracy of Aortic Regurgitation Severity Grading by Echocardiography Versus Cardiac Magnetic Resonance Imaging
Section snippets
Methods
The study was divided into 4 phases. In the calibration phase, we performed a baseline assessment of interobserver agreement and majority accuracy against a reference standard. The consensus phase involved formulation of a consensus document to standardize the grading of AR. In the validation phase, we checked the accuracy of the consensus document-based AR grading against the cardiac MRI findings. Finally, the recalibration phase involved updating all readers with the consensus document and a
Results
The clinical and echocardiographic characteristics of the studied patients are listed in Table 1. The mean ejection fraction was within the normal range, but the ventricles were generally enlarged. The baseline concordance among the readers was suboptimal, with an average kappa of 0.5 and the lowest kappa (0.4) for moderate AR. Agreement of >80% of readers was observed for only 13 of the 20 patients (Figure 1). Logistic regression analysis did not show a statistically significant association
Discussion
The findings of the present study showed there was suboptimal multireader concordance in the grading severity of AR, which appeared to be attributable to a lack of hierarchy of the key parameters recommended for use in grading of AR severity. Our study has demonstrated that multireader concordance and accuracy can be improved by a simple algorithmic approach (Figure 5) derived from a LV volume-based consensus document. The lack of preferential weighting of the key parameters in which the
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