Doppler assessment of aortic stenosis: a 25-operator study demonstrating why reading the peak velocity is superior to velocity time integral.
Doppler assessment of aortic stenosis: a 25-operator study demonstrating why reading the peak velocity is superior to velocity time integral.
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DOI：
10.1093/ehjci/jex218
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发表时间：
2018-12-01
期刊：
影响因子：
--
通讯作者：
Cole GD
中科院分区：
文献类型：
--
作者：
Sacchi S;Dhutia NM;Shun-Shin MJ;Zolgharni M;Sutaria N;Francis DP;Cole GD
具有上级再现性的测量在临床和研究目的上是有用的。以前的多普勒评估主动脉瓣狭窄（AS）的再现性研究只比较了一对观察者，并没有探讨操作者之间发生分歧的机制。使用定制设计的软件，存储运营商的痕迹，我们调查了再现性的峰值和速度时间积分（VTI）测量在一个更大的组的运营商，并探讨了产生分歧的机制。25名观察员随机回顾了20例AS患者的连续波（CW）主动脉瓣（AV）和脉冲波（PW）左室流出道（LVOT）多普勒描记。每名操作员在不知情的情况下测量了两次峰值速度和VTI。储存VTI描记以供比较。对于PW（变异系数10.1 vs. 18.0%; P < 0.001）和CW迹线（变异系数4.0 vs. 10.2%; P < 0.001），测量峰值的重现性比VTI高得多。VTI较差，因为包络线的陡峭的早期和晚期部分难以再现地追踪。由于操作员倾向于对同一患者的LVOT和AV描记线进行一致的过度读取或欠读，因此无闪烁指数可提高再现性（变异系数9.3 vs. 17.1%; P < 0.001）。与VTI相比，测量多普勒迹线峰值的可重复性要高得多，该策略可将测量方差降低约六倍。峰值测量上级VTI，因为追踪VTI包络线早期和晚期的陡峭斜率很难重复实现。
Measurements with superior reproducibility are useful clinically and research purposes. Previous reproducibility studies of Doppler assessment of aortic stenosis (AS) have compared only a pair of observers and have not explored the mechanism by which disagreement between operators occurs. Using custom-designed software which stored operators’ traces, we investigated the reproducibility of peak and velocity time integral (VTI) measurements across a much larger group of operators and explored the mechanisms by which disagreement arose. Twenty-five observers reviewed continuous wave (CW) aortic valve (AV) and pulsed wave (PW) left ventricular outflow tract (LVOT) Doppler traces from 20 sequential cases of AS in random order. Each operator unknowingly measured each peak velocity and VTI twice. VTI tracings were stored for comparison. Measuring the peak is much more reproducible than VTI for both PW (coefficient of variation 10.1 vs. 18.0%; P < 0.001) and CW traces (coefficient of variation 4.0 vs. 10.2%; P < 0.001). VTI is inferior because the steep early and late parts of the envelope are difficult to trace reproducibly. Dimensionless index improves reproducibility because operators tended to consistently over-read or under-read on LVOT and AV traces from the same patient (coefficient of variation 9.3 vs. 17.1%; P < 0.001). It is far more reproducible to measure the peak of a Doppler trace than the VTI, a strategy that reduces measurement variance by approximately six-fold. Peak measurements are superior to VTI because tracing the steep slopes in the early and late part of the VTI envelope is difficult to achieve reproducibly.
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DOI：
10.6028/jres.070c.025
发表时间：
1966-01-01
期刊：
JOURNAL OF RESEARCH OF THE NATIONAL BUREAU OF STANDARDS SECTION C-ENGINEERING AND INSTRUMENTATION
影响因子：
--
作者：
KU, HH
通讯作者：
KU, HH
影响因子：
37.8
作者：
ZOGHBI, WA;FARMER, KL;QUINONES, MA
通讯作者：
QUINONES, MA
DOI：
10.1016/0735-1097(90)90280-3
发表时间：
1990-03-15
影响因子：
24
作者：
ROTHBART, RM;CASTRIZ, JL;TEAGUE, SM
通讯作者：
TEAGUE, SM
影响因子：
2.8
作者：
OTTO, CM;NISHIMURA, RA;BASHORE, TM
通讯作者：
BASHORE, TM
DOI：
10.1016/s0735-1097(86)80382-5
发表时间：
1986-11-01
影响因子：
24
作者：
TEIRSTEIN, P;YEAGER, M;POPP, RL
通讯作者：
POPP, RL