title: Interobserver and Intraobserver Agreement on Qualitative Assessments of Right Ventricular Dysfunction With Echocardiography in Patients With Pulmonary Embolism.
abstract: OBJECTIVE
  To evaluate observer agreement using qualitative goal-directed echocardiographic criteria for right ventricular (RV) dysfunction prognostication in submassive pulmonary embolism (PE).
  
  
  METHODS
  Two emergency physicians and 2 cardiologists independently reviewed 31 packets of goal-directed echocardiographic video clips consisting of at least 3 windows obtained by emergency physicians from normotensive patients with PE. Nine packets were repeated to assess for intraobserver agreement. Right ventricular dysfunction criteria on goal-directed echocardiography were as follows: RV enlargement was present, with a right-to-left ventricular basal diameter ratio of 1.0 or higher and blunting of the apex of the RV in 2 or more different windows; RV systolic dysfunction was present if the tricuspid annulus moved toward the apex 10 mm or less and there was RV free wall hypokinesis; and septal deviation was present with any flattening or deviation of the ventricular septum toward the left ventricle.
  
  
  RESULTS
  Among the 4 participants, there was 83.9% agreement on the presence or absence of RV enlargement (κ = 0.84), 74.2% agreement on the presence or absence of RV systolic dysfunction (κ = 0.69), and 71.0% agreement on the presence or absence of septal deviation (κ = 0.59). Intraobserver agreement was 100% for each RV dysfunction variable for each observer (κ = 1.0).
  
  
  CONCLUSIONS
  Agreement was substantial for both severe RV enlargement and RV systolic dysfunction and moderate for septal deviation. Right ventricular dysfunction assessment with qualitative goal-directed echocardiographic criteria is reproducible for PE risk stratification.
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina USA anthony.weekes1@gmail.com.
authors: Anthony J
authors: AJ
authors: Weekes
authors: Emory University, Atlanta, Georgia USA.
authors: Laura
authors: L
authors: Oh
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina USA.
authors: Gregory
authors: G
authors: Thacker
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina USA.
authors: Angela K
authors: AK
authors: Johnson
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina USA.
authors: Michael
authors: M
authors: Runyon
authors: Sanger Cardiology, Carolinas Medical Center, Charlotte, North Carolina USA.
authors: Geoffrey
authors: G
authors: Rose
authors: Sanger Cardiology, Carolinas Medical Center, Charlotte, North Carolina USA.
authors: Thomas
authors: T
authors: Johnson
authors: Biostatistics Facility, Carolinas Medical Center, Charlotte, North Carolina USA.
authors: Megan
authors: M
authors: Templin
authors: Biostatistics Facility, Carolinas Medical Center, Charlotte, North Carolina USA.
authors: H James
authors: HJ
authors: Norton
mesh_terms: D004452:Echocardiography / Q000379:methods*; D005069:Evaluation Studies as Topic; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D015588:Observer Variation; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: echocardiography; observer agreement; pulmonary embolism; right ventricular dysfunction