title: Impact of Variability in Echocardiographic Interpretation on Assessment of Adequacy of Repair Following Congenital Heart Surgery: A Pilot Study.
abstract: Technical Performance Score (TPS) is based largely on the presence and magnitude of residual lesions on postoperative echocardiograms; this score correlates with outcomes following repair of congenital heart defects. We evaluated reader variability for echocardiographic components of TPS for complete repair of tetralogy of Fallot (TOF) and arterial switch operation (ASO) in two centers and measured its effect on TPS. Postoperative echocardiograms were evaluated in 67 children (39 TOF and 28 ASO). Two readers (one per center) interpreted each echocardiogram. Reader variability in image quality assessments and measurements was compared using weighted kappa (κ), percent agreement, and intra-class correlation. TPS class (1 optimal-no residua, 2 adequate-minor residua, 3 inadequate-major residua) was assigned for each echocardiographic review by an independent investigator. The effect of reader interpretation variability on TPS classification was measured. There was strong agreement for TPS between the two readers (κ = 0.88). The readers were concordant for TPS classes for 57 children (85%) and discordant for classes 2 (minor residua) versus 3 (major residua) in six (9%). Coronary arteries and branch pulmonary arteries were frequently suboptimally visualized. Although inter-reader agreement for TPS was strong, inter-reader variation in echocardiographic interpretations had a small, but important effect on TPS for TOF and ASO, particularly for the distinction between minor and major residua. Further studies of generalizability and reproducibility of TPS and refinement of scoring modules may be needed before it can be used as a tool to assess pediatric cardiac surgical performance and outcomes.
authors.affiliation: Heart Center, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA. aparthiban@cmh.edu.
authors.forename: Anitha
authors.initials: A
authors.lastname: Parthiban
authors.affiliation: Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.|Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
authors.forename: Jami C
authors.initials: JC
authors.lastname: Levine
authors.affiliation: Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.|Department of Cardiac Surgery, Boston Children's Hospital, Bader 665, 300 Longwood Ave, Boston, MA, 02115, USA.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.affiliation: Heart Center, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Marshall
authors.affiliation: Heart Center, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
authors.forename: Girish S
authors.initials: GS
authors.lastname: Shirali
authors.affiliation: Department of Biostatistics, University of Missouri Kansas City School of Medicine, 2411 Holmes street, Kansas City, MO, 64108, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Simon
authors.affiliation: Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.|Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
authors.forename: Steve D
authors.initials: SD
authors.lastname: Colan
authors.affiliation: Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.|Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.affiliation: Heart Center, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
authors.forename: Geetha
authors.initials: G
authors.lastname: Raghuveer
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results
keywords: Cardiac surgery outcomes; Children; Congenital heart disease; Echocardiographic image quality; Echocardiographic variability; Residual lesions