Reliability of visual assessment of global and segmental left ventricular function: a multicenter study by the Israeli Echocardiography Research Group.
BACKGROUND
The purpose of this multicenter study was to determine the reliability of visual assessments of segmental wall motion (WM) abnormalities and global left ventricular function among highly experienced echocardiographers using contemporary echocardiographic technology in patients with a variety of cardiac conditions.


METHODS
The reliability of visual determinations of left ventricular WM and global function was calculated from assessments made by 12 experienced echocardiographers on 105 echocardiograms recorded using contemporary echocardiographic equipment. Ten studies were reread independently to determine intraobserver reliability.


RESULTS
Interobserver reliability for visual differentiation between normal, hypokinetic, and akinetic segments had an intraclass correlation coefficient of 0.70. The intraclass correlation coefficient for dichotomizing segments into normal versus other abnormal was 0.63, for hypokinetic versus other scores was 0.26, and for akinetic versus other scores was 0.58. Similar results were found for intraobserver reliability. Interobserver reliability for WM score index was 0.84 and for left ventricular ejection fraction was 0.78. Similar values were obtained for the intraobserver reliability of WM score index and ejection fraction. Compared to angiographic data, the accuracy of segmental WM assessments was 85%, and correct determination of the culprit artery was achieved in 59% of patients with myocardial infarctions.


CONCLUSIONS
Among experienced readers using contemporary echocardiographic equipment, interobserver and intraobserver reliability was reasonable for the visual quantification of normal and akinetic segments but poor for hypokinetic segments. Reliability was good for the visual assessment of global left ventricular function by WM score index and ejection fraction.
Hillel-Yaffe Medical Center, Hadera, Israel. dsblond@gmail.com
David S
DS
Blondheim
Ronen
R
Beeri
Micha S
MS
Feinberg
Mordehay
M
Vaturi
Sarah
S
Shimoni
Wolfgang
W
Fehske
Alik
A
Sagie
David
D
Rosenmann
Peter
P
Lysyansky
Lisa
L
Deutsch
Marina
M
Leitman
Rafael
R
Kuperstein
Ilan
I
Hay
Dan
D
Gilon
Zvi
Z
Friedman
Yoram
Y
Agmon
Yossi
Y
Tsadok
Noah
N
Liel-Cohen
D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*