title: Interobserver and intraobserver variability in detection of patent foramen ovale and atrial septal aneurysm with transesophageal echocardiography.
abstract: BACKGROUND
  An accurate diagnosis of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) may be of decisional importance in the management of patients with ischemic stroke. Very few studies have been devoted to observer agreement in the diagnosis of these atrial septum abnormalities using contrast transesophageal echocardiography, which is considered as the method of choice for the diagnosis. The aim of this study was to assess interobserver and intraobserver variability in the diagnosis of PFO and ASA with contrast echocardiography.
  
  
  METHODS
  Three sonographers independently reviewed 100 contrast studies stored on videotape on 2 occasions each. The interobserver and intraobserver variability was assessed by calculating kappa statistics.
  
  
  RESULTS
  The overall interobserver and intraobserver kappa values for the assessment of degree of shunting through a PFO were 0.77 (first and second reading) and 0.82, respectively. The best kappa statistics were obtained when no and small shunts (less than 10 microbubbles) were pooled and compared with larger shunts. For the diagnosis of ASA, the overall interobserver kappa value was 0.45 for the first reading and 0.71 for the second reading, whereas the overall intraobserver kappa value was 0.74.
  
  
  CONCLUSIONS
  Interobserver and intraobserver agreements for the diagnosis of PFO and ASA by transesophageal echocardiography are not perfect and need to be improved, particularly for ASA. This variability has to be taken into account when deciding on a potential risky treatment to prevent recurrent strokes.
authors.affiliation: Service de Cardiologie, Hôpital Cochin, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Cabanes
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Geneviève
authors.initials: G
authors.lastname: Derumeaux
authors.forename: Xavier
authors.initials: X
authors.lastname: Jeanrenaud
authors.forename: Catherine
authors.initials: C
authors.lastname: Lamy
authors.forename: Mathieu
authors.initials: M
authors.lastname: Zuber
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
mesh_terms: D000328:Adult; D017548:Echocardiography, Transesophageal; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging*; D006325:Heart Atria; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging*; D006346:Heart Septum; D006801:Humans; D008297:Male; D015588:Observer Variation; D014741:Video Recording