title: Specificity of Doppler echocardiography for the assessment of changes in valvular regurgitation: comparison of side-by-side versus serial interpretation.
abstract: OBJECTIVE
  We sought to determine the specificity of two different methods for assessing change in aortic (AR), mitral (MR) and tricuspid (TR) valvular regurgitation.
  
  
  BACKGROUND
  Echocardiographic imaging with Doppler is the standard noninvasive diagnostic tool for assessing valvular structure and function. Change can be assessed using either independent evaluations (serial) or using a side-by-side comparison.
  
  
  METHODS
  Subjects were from the placebo arm of a randomized, double-blind, clinical trial. Three echocardiograms over 10 months were performed. An initial and three-month echocardiogram were read as independent groups, blinded to all parameters except sequence. The initial and 10-month echocardiograms were read side-by-side, blinded to all parameters including sequence.
  
  
  RESULTS
  Two hundred nineteen predominantly healthy, obese, white, middle-aged women had initial and three-month echocardiograms (acquisition interval 105 +/- 28 days) evaluated by the serial method (mean 167 +/- 61 days between interpretations). The same subjects had the initial and 10-month studies (acquisition interval 303 +/- 27 days) compared side-by-side. The specificity of the serial versus side-by-side method for determining change in MR grade was 55.8% versus 93.2% (p < 0.001); TR: 63.8% versus 97.6% (p < 0.001) and AR: 93.7% versus 97.6 (p = 0.08). Notably, most of the change occurred in a range (none versus physiologic/mild) that has limited clinical significance. Furthermore, the percentage of echocardiograms interpreted as nonevaluable was lower with the side-by-side method for MR (5.0% vs. 16.0%, p = 0.06), TR (4.6% vs. 15.5%, p < 0.001) and AR (4.1% vs. 12.3%, p = 0.002).
  
  
  CONCLUSIONS
  The side-by-side method of assessing change in valvular regurgitation appears to be the more reliable method with a higher specificity and minimal data loss.
authors.affiliation: Cardiovascular Research Institute, Washington Hospital Center, DC, USA. njw1@mhg.edu
authors.forename: N J
authors.initials: NJ
authors.lastname: Weissman
authors.forename: J A
authors.initials: JA
authors.lastname: Panza
authors.forename: J F
authors.initials: JF
authors.lastname: Tighe
authors.forename: S T
authors.initials: ST
authors.lastname: Perras
authors.forename: H
authors.initials: H
authors.lastname: Kushner
authors.forename: J S
authors.initials: JS
authors.lastname: Gottdiener
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018450:Disease Progression; D004311:Double-Blind Method; D015150:Echocardiography, Doppler / Q000379:methods* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015588:Observer Variation; D012680:Sensitivity and Specificity; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology