title: The role of experience in echocardiographic identification of location and extent of mitral valve prolapse with 2D and 3D echocardiography.
abstract: Contradiction exists on the incremental value of two-dimensional (2D) and 3D transoesophageal echocardiography (TOE) over 2D transthoracic echocardiography (TTE) for the detection of mitral valve (MV) prolapse in readers with different echocardiographic experience. Twenty patients and five healthy persons were retrospectively identified who had undergone 2D-TTE, 2D-TOE and 3D-TOE. Fifteen (75 %) patients had surgical evidence of prolapse of the posterior MV leaflet and five patients (25 %) had a dilated MV annulus without prolapse. Three reader groups with different echocardiographic expertise (novice, trainees, cardiologists) scored thus in total 675 posterior scallops. Overall there was an improvement in agreement and Kappa values from novice to trainees to cardiologists. Diagnostic accuracies of 2D-TOE were higher than those of 2D-TTE mainly in novice readers. The incremental value of 3D-TOE over 2D-TOE was mainly seen in specificities. Time to diagnosis was dramatically reduced from 2D to 3D-TEE in all reader groups (all P < 0.001). 3D-TOE also improved the agreement (+12 to +16 %) and Kappa values (+0.14 to +0.21) in all reader groups for the exact description of P2 prolapse. Differences between readers with variable experience in determining the precise localization and extent of the prolapsing posterior MV scallops exist in particular in 2D-TTE analysis. 3D-TOE analysis was extremely fast compared to the 2D analysis methods and showed the best diagnostic accuracy (mainly driven by specificity) with identification of P1 and P3 prolapse still improving from novice to trainees to cardiologists and provided optimal description of P2 prolapse extent.
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. l.delaat@erasmusmc.nl.|Department of Cardiothoracic Surgery, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands. l.delaat@erasmusmc.nl.
authors.forename: Lotte E
authors.initials: LE
authors.lastname: de Groot-de Laat
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Ren
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Jacky
authors.initials: J
authors.lastname: McGhie
authors.affiliation: Department of Cardiothoracic Surgery, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Frans B S
authors.initials: FB
authors.lastname: Oei
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Mihai
authors.initials: M
authors.lastname: Strachinaru
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Sharon W M
authors.initials: SW
authors.lastname: Kirschbaum
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|Department of Intensive Care, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Sakir
authors.initials: S
authors.lastname: Akin
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Kievit
authors.affiliation: Department of Cardiothoracic Surgery, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.affiliation: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
mesh_terms: D000368:Aged; D002983:Clinical Competence; D057210:Delayed Diagnosis; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Mitral valve prolapse; Three-dimensional echocardiography; Two-dimensional echocardiography