Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation
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DOI：
10.1007/s10554-015-0659-1
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发表时间：
2015-10-01
影响因子：
2.1
通讯作者：
Francis, Darrel P.
中科院分区：
文献类型：
--
作者：
Cole, Graham D.;Dhutia, Niti M.;Francis, Darrel P.
左心室功能可以通过定性分级和射血分数（EF）的肉眼估计来评估。我们试图定义这些技术的可重复性，以及它们如何受到图像质量、经验和认证的影响。 20 个具有不同图像质量和左心室功能的心尖四腔超声心动图电影循环（在线资源 1-20）被匿名化并呈现给 35 名操作员。操作员被要求提供 (1) 整体收缩功能的单短语分级 (2) “眼球”EF 估计值和 (3) 0-100 视觉模拟量表的图像质量评级。每个观察者在不知不觉中将每个循环观看了两次，总共观看了 1400 次。当将左心室功能分为五类时，操作者与另一操作者达成一致的几率为 50%，而在盲法再现中与自己达成一致的几率为 68%。同一操作员盲眼 LVEF 重新估计的标准差 (SD) 为 7.6 EF 单位，不同操作员之间的 SD 平均为 8.3 EF 单位。图像质量定义为所有操作员评估的平均值，与 EF 估计变异性 (r = -0.616，p < 0.01) 和视觉分级一致性 (r = 0.58，p < 0.01) 相关。然而，操作员自己的单一质量评估并不能有效预警他们的估计是否异常，部分原因是个体质量评估在操作员内的再现性较差（差异标准差为 17.8）。左室功能视觉分级和 LVEF 估计的可重复性取决于图像质量，但个人无法自己识别不良图像质量何时会干扰他们的左室功能估计。临床医生不应假设患者的分级或目视估计 EF 发生变化，从而发生了真正的临床变化。
Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1-20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an "eyeball" EF estimate and (3) an image quality rating on a 0-100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator's chance of agreement with another operator was 50 % and with themself on blinded re-presentation was 68 %. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators' assessments, correlated with EF estimate variability (r = -0.616, p < 0.01) and visual grading agreement (r = 0.58, p < 0.01). However, operators' own single quality assessments were not a useful forewarning of their estimate being an outlier, partly because individual quality assessments had poor within-operator reproducibility (SD of difference 17.8). Reproducibility of visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.