The Inter-rater Reliability of Echocardiographic Diastolic Function Evaluation Among Emergency Physician Sonographers.
OBJECTIVE
In a patient with dyspnea and suspected CHF, the evaluation of diastolic function involves: tissue Doppler of the mitral annulus and 2) pulsed wave Doppler of the mitral inflow. We aimed to 1) determine the inter-rater reliability for overall diastolic function and 2) evaluate the reliability of the individual Doppler measurements.


METHODS
A convenience sample of adult emergency department patients was prospectively enrolled by 8 EPs who had participated in a 1-hour didactic session. Patients were selected if they had a history of CHF or suspected abnormal diastolic function due to chronic hypertension. Diastolic function was considered to be abnormal if Tissue Doppler of the septal e' was <8 cm/s and if the lateral e' was <10 cm/s. In cases of discordance, the E/e' ratio was calculated with ≤8 considered normal and >8 considered abnormal. A Kappa coefficient. Bland-Altman plot and a fixed effect regression model were used in the analysis.


RESULTS
Thirty-two patients were enrolled, and 3 (9.4%) were excluded due to technical inadequacy. The inter-rater reliability among sonographers for overall interpretation was very good: κ = 0.86 (95% CL [0.67, 1.0]). Based on the Bland-Altman plot, was no consistent bias between readers. There was no evidence to conclude that the readings differed among sonographers: septal e' (p = 0.77), lateral e' (p = 0.89) and E (p = 0.15).


CONCLUSIONS
EP sonographers obtained similar Doppler measurements for diastolic function evaluation with very good inter-rater reliability for the assessment of overall diastolic function.
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Turandot
T
Saul
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Nicholas C
NC
Avitabile
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Rachel
R
Berkowitz
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Sebastian D
SD
Siadecki
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Gabriel
G
Rose
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Mojdeh
M
Toomarian
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Nicole L
NL
Kaban
Division of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, New York.
Nicholas
N
Governatori
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Maria
M
Suprun
D003971:Diastole; D015150:Echocardiography, Doppler; D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results
bedside ultrasound; congestive heart failure; echocardiography