title: Measuring the quality of echocardiography using the predictive value of the left ventricular ejection fraction.
abstract: BACKGROUND
  One of the main challenges for imaging laboratories is demonstrating the quality of their studies. The aim of this study was to determine if echocardiographic training and experience are associated with the accuracy of left ventricular ejection fraction (LVEF) reporting using all-cause mortality as the gold standard.
  
  
  METHODS
  Survival was determined for consecutive patients undergoing echocardiography at one of four academic facilities. The relationship between LVEF and survival was determined for different groups of physician readers and sonographers on the basis of board certification and experience. Studies of physicians reading <200 studies were excluded.
  
  
  RESULTS
  Data from 63,108 patients and 40 physicians were included. There was moderate variation across physicians in the relationship between LVEF and 1-year mortality (area under the receiver operating characteristic curve interquartile range, 0.56-0.64). The relationship between LVEF and 1-year mortality was stronger for physicians board certified in echocardiography (area under the receiver operating characteristic curve, 0.60; 95% confidence interval, 0.59-0.61) compared with those not certified (area under the receiver operating characteristic curve, 0.56; 95% confidence interval, 0.55-0.57; P < .0001). Physician experience, years since training, and sonographer experience and certification were not clearly associated with the predictive value of LVEF. After adjustment for patient characteristics, the LVEF-mortality association of board-certified physicians remained stronger than the LVEF-mortality association of those not certified.
  
  
  CONCLUSIONS
  LVEF as determined by physicians board certified in echocardiography was associated with a stronger relationship with mortality than as determined by those not certified. The LVEF-mortality relationship may be useful as one measure of the quality of imaging.
authors: VA Palo Alto Health Care System, Palo Alto, California, USA. heiden@stanford.edu
authors: Paul A
authors: PA
authors: Heidenreich
authors: Thomas M
authors: TM
authors: Maddox
authors: Jayant
authors: J
authors: Nath
mesh_terms: D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality*; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000592:standards*; D003120:Colorado / Q000453:epidemiology; D004452:Echocardiography / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000592:standards*; D012372:ROC Curve; D012042:Registries; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D016277:Ventricular Function, Left