title: Interobserver reliability of echocardiography for prognostication of normotensive patients with pulmonary embolism.
abstract: OBJECTIVE
  To evaluate the interobserver reliability of echocardiographic findings of right ventricle (RV) dysfunction for prognosticating normotensive patients with pulmonary embolism (PE).
  
  
  METHODS
  A central panel of cardiologists evaluated echocardiographic studies of 75 patients included in the PROTECT study for the following signs: RV diameter, RV/left ventricular (LV) diameter ratio, hypokinesis of the RV free wall, and tricuspid plane systolic excursion (TAPSE). Investigators used intraclass correlation to assess agreement between the measurements of the central panel and each of the local cardiologists. Investigators used the single weighted kappa statistic to test for agreement between readers of interpretation of RV enlargement and RV hypokinesis.
  
  
  RESULTS
  The two observers had fair agreement (k = 0.45) for RV enlargement assessed by the RV diameter, and good agreement (k = 0.65) for RV enlargement assessed by the RV/LV diameter ratio. The interobserver reliability of the assessment whether hypokinesis of the RV free wall is present was good (к = 0.70), and whether RV dysfunction (assessed by TAPSE measurement) is present was very good (k = 0.86). The intraclass correlation for the RV/LV diameter ratio was fair (0.55; 95% confidence interval [CI], 0.37-0.69), for the RV diameter was good (0.70; 95% CI, 0.56-0.80), and for the TAPSE measurement was very good (0.85; 95% CI, 0.77-0.90). On Bland-Altman analysis, the mean differences for RV diameter, RV/LV diameter ratio and TAPSE measurement were 2.33 (±5.38), 0.06 (±0.23) and 0.08 (±2.20), respectively.
  
  
  CONCLUSIONS
  TAPSE measurement is the least user dependent and most reproducible echocardiographic finding of RV dysfunction in normotensive patients with PE.
authors.forename: Dita
authors.initials: D
authors.lastname: Kopecna
authors.forename: Sem
authors.initials: S
authors.lastname: Briongos
authors.forename: Hugo
authors.initials: H
authors.lastname: Castillo
authors.forename: Carlos
authors.initials: C
authors.lastname: Moreno
authors.forename: Mónica
authors.initials: M
authors.lastname: Recio
authors.forename: Paula
authors.initials: P
authors.lastname: Navas
authors.forename: José Luis
authors.initials: JL
authors.lastname: Lobo
authors.forename: Angel
authors.initials: A
authors.lastname: Alonso-Gomez
authors.forename: Izaskun
authors.initials: I
authors.lastname: Obieta-Fresnedo
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernández-Golfin
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, 28034 Madrid, Spain. djc_69_98@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging*; D011859:Radiography; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013030:Spain; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology*
references.citation: Eur Heart J. 2008 Jun;29(12):1569-77
references.pmid: 18495689
references.citation: J Am Coll Cardiol. 1997 Nov 1;30(5):1165-71
references.pmid: 9350909
references.citation: Circulation. 2000 Jun 20;101(24):2817-22
references.pmid: 10859287
references.citation: Chest. 2007 Jun;131(6):1844-51
references.pmid: 17400663
references.citation: J Thromb Haemost. 2014 Jul;12(7):1020-7
references.pmid: 24766779
references.citation: Am J Cardiol. 2002 Oct 1;90(7):778-81
references.pmid: 12356399
references.citation: JAMA. 1976 Sep 27;236(13):1477-80
references.pmid: 989113
references.citation: Arch Intern Med. 1997 Dec 8-22;157(22):2593-8
references.pmid: 9531228
references.citation: Eur Heart J. 2008 Sep;29(18):2276-315
references.pmid: 18757870
references.citation: Ann Intern Med. 2002 May 7;136(9):691-700
references.pmid: 11992305
references.citation: Arch Intern Med. 2005 Aug 8-22;165(15):1777-81
references.pmid: 16087827
references.citation: Thorax. 2014 Feb;69(2):109-15
references.pmid: 23525079
references.citation: N Engl J Med. 1992 May 7;326(19):1240-5
references.pmid: 1560799
references.citation: Heart. 1997 Apr;77(4):346-9
references.pmid: 9155614
references.citation: Lancet. 1993 Feb 27;341(8844):507-11
references.pmid: 8094768
references.citation: Lancet. 1986 Feb 8;1(8476):307-10
references.pmid: 2868172
references.citation: Lancet. 1999 Apr 24;353(9162):1386-9
references.pmid: 10227218
references.citation: Am Heart J. 1997 Sep;134(3):479-87
references.pmid: 9327706
references.citation: Am Heart J. 1984 Mar;107(3):526-31
references.pmid: 6695697
references.citation: Chest. 2004 Apr;125(4):1539-45
references.pmid: 15078772
references.citation: Arch Intern Med. 2004 Aug 9-23;164(15):1685-9
references.pmid: 15302640
references.citation: Vasc Med. 2010 Oct;15(5):419-28
references.pmid: 20926501
references.citation: Radiology. 1992 Nov;185(2):381-7
references.pmid: 1410342