title: Variability of Doppler microembolic signal counts in patients with prosthetic cardiac valves.
abstract: OBJECTIVE
  The purpose of this study was the evaluation of intraobserver, interobserver, and intrasubject variability in the Doppler detection of microembolic signals in patients with mechanical prosthetic valves. Simultaneously, the feasibility of automated embolus detection by means of a neuronal network was investigated.
  
  
  METHODS
  From 25 patients with mechanical prosthetic heart valves, single transcranial Doppler monitoring sessions of 30 minutes' duration were recorded on videotape, randomized, and subsequently analyzed by eight independent trained observers from three centers. Three observers evaluated these tapes on three separate occasions, blinded to their previous results. An additional 48 patients with prosthetic heart valves were repetitively monitored with transcranial Doppler ultrasonography for 30 minutes three times within 1 year to examine the long-term variability in the occurrence of microembolic signals. Finally, in an effort to assess the short-term intrasubject variability, 20 patients were examined for 90 minutes, and the results of the three 30-minute periods were compared. The interobserver, intraobserver, and intrasubject (both short- and long-term) variability was evaluated.
  
  
  RESULTS
  No significant differences in microembolic signal counts were found among the different observers, between the human observers and the neuronal network, or among the three separate evaluations of stored data by the same observer. The same was true for repeat examinations of the same patient (P > .05, Student's two-paired t test and Friedman's test).
  
  
  CONCLUSIONS
  The detection of microembolic signals in patients with prosthetic cardiac valves is a reproducible technique. The reliable performance of the neuronal network argues for a broader use of this device. The intrasubject stability of the microembolic rate over 1 year supports the concept that the underlying emboligenic process is associated with intrinsic mechanical properties of the valve implant and not due to a thromboembolic process in the heart.
authors.affiliation: University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK.
authors.forename: D
authors.initials: D
authors.lastname: Georgiadis
authors.forename: M
authors.initials: M
authors.lastname: Kaps
authors.forename: M
authors.initials: M
authors.lastname: Siebler
authors.forename: M
authors.initials: M
authors.lastname: Hill
authors.forename: M
authors.initials: M
authors.lastname: König
authors.forename: J
authors.initials: J
authors.lastname: Berg
authors.forename: M
authors.initials: M
authors.lastname: Kahl
authors.forename: P
authors.initials: P
authors.lastname: Zunker
authors.forename: B
authors.initials: B
authors.lastname: Diehl
authors.forename: E B
authors.initials: EB
authors.lastname: Ringelstein
mesh_terms: D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging*; D008297:Male; D008838:Microcomputers; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016571:Neural Networks, Computer; D015588:Observer Variation; D011474:Prosthesis Design; D015203:Reproducibility of Results; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial; D014743:Videotape Recording