Abstract
Study Objectives
In a patient with dyspnea and suspected CHF, the evaluation of diastolic function
involves: tissue Doppler of the mitral annulus and 2) pulsed wave Doppler of the mitral
inflow. We aimed to 1) determine the inter-rater reliability for overall diastolic
function and 2) evaluate the reliability of the individual Doppler measurements.
Methods
A convenience sample of adult emergency department patients was prospectively enrolled
by 8 EPs who had participated in a 1-hour didactic session. Patients were selected
if they had a history of CHF or suspected abnormal diastolic function due to chronic
hypertension. Diastolic function was considered to be abnormal if Tissue Doppler of
the septal e′ was <8 cm/s and if the lateral e′ was <10 cm/s. In cases of discordance,
the E/e′ ratio was calculated with ≤8 considered normal and >8 considered abnormal.
A Kappa coefficient. Bland-Altman plot and a fixed effect regression model were used
in the analysis.
Results
Thirty-two patients were enrolled, and 3 (9.4%) were excluded due to technical inadequacy.
The inter-rater reliability among sonographers for overall interpretation was very
good: κ = 0.86 (95% CL [0.67, 1.0]). Based on the Bland-Altman plot, was no consistent
bias between readers. There was no evidence to conclude that the readings differed
among sonographers: septal e′ (p = 0.77), lateral e′ (p = 0.89) and E (p = 0.15).
Conclusion
EP sonographers obtained similar Doppler measurements for diastolic function evaluation
with very good inter-rater reliability for the assessment of overall diastolic function.
Keywords
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Article info
Publication history
Published online: September 07, 2016
Accepted:
June 2,
2016
Received in revised form:
January 16,
2016
Received:
October 16,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
