Interobserver variability in echocardiography

Vignola, Paul A.; Bloch, A; Kaplan, Alan D.; Walker, Harriet; Chiotellis, Philip N.; Myers, Gordon S.

doi:10.1002/jcu.1870050405

Cited by 45 publications

(14 citation statements)

References 16 publications

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“…43 Studies on reproducibility and variability report that the percentage error for wall thickness is higher than that for left ventricular minor axis diameter. 42 -44 " 46 However, reproducibility of a wall thickness of 12 mm or more or of cardiac disease as compared to a wall thickness of 11 mm or less of normal subjects is much better, and the error is usually less than lO'fo. Although we do not have our own data on left ventricular wall thickness measurements in normal subjects, we have used 11 mm as the upper limit of normal, based on data from other reported studies.…”

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confidence: 99%

Detection of hypertensive left ventricular hypertrophy.

Carr¹,

Lm²,

Watkins³

1985

Hypertension

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SUMMARY The risk of adverse cardiovascular events is higher in persons with electrocardiographic evidence of left ventricular hypertrophy, and the decision to treat patients with antihypertensive drugs is often determined by the presence of hypertrophy. In this study a number of electrocardiographic criteria for detection of left ventricular hypertrophy were applied to a population of 85 hypertensive subjects in an ongoing outpatient hypertension evaluation and treatment program. Included were one set of criteria in common use and three sets of criteria employed in prospective clinical trials. The results were compared with those obtained by M-mode echocardiography and left ventricular wall thickness of 12 mm or more, which was taken as an indicator of hypertrophy. By this criterion, 34 patients (40%) had left ventricular hypertrophy. The most sensitive of the electrocardiographic criteria allowed detection of only 13 (38%) of those hypertensive subjects with anatomicalechocardiographic left ventricular hypertrophy. Although the echocardiogram is more time-consuming to obtain and more expensive than the electrocardiogram, its superior sensitivity suggests that the echocardiogram should be used for evaluating patients with high blood pressure, especially those without electrocardiographic evidence of left ventricular hypertrophy, to detect anatomical left ventricular hypertrophy. (Hypertension 7: 948-954, 1985) KEY WORDS hypertension echocardiography • left ventricular hypertrophy • electrocardiography I N the Framingham Study, the presence of defined electrocardiographic (ECG) evidence of left ventricular hypertrophy (LVH) in the hypertensive subjects was associated with a higher incidence of stroke and heart failure than if this evidence was absent. '• 2 This finding was also associated with increased incidence of coronary heart disease independent of the blood pressure level.' Similarly, in prospective clinical trials of drug intervention on the natural history of hypertension, such as the Veterans Administration Cooperative Study (VACS), 3 the benefit of vigorous therapy was more apparent in subjects with a variety of indicators of end-organ damage, including ECG evidence of LVH, than in those without. The ECG criteria for LVH have been used to exclude or stratify subjects in the design of clinical trials of drug treatment in hypertension. The Oslo study 4 excluded subjects with ECG evidence of LVH, and it is of interest that this abnormality developed only in untreated control paFrom the Department of Medicine, Medical College of Georgia, Augusta, Georgia.Presented at the 56th Scientific Session, American Heart Association, November 14-17, 1983, Anaheim, California.Address for reprints: Dr. Albert A. Can, Hypertension Section, BD-133, Medical College of Georgia, Augusta, Georgia 30912.Submitted August 20, 1984; accepted April 9, 1985. tients during the trial. In the Hypertension Detection and Follow-up Program (HDFP) 5 ECG evidence of LVH, diagnosed on the basis of voltage criteria only, was present in...

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confidence: 99%

Detection of hypertensive left ventricular hypertrophy.

Carr¹,

Lm²,

Watkins³

1985

Hypertension

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“…15 of the included 51 studies were published before the year 2000, while 36 were published from 2000 onwards. The oldest publication dates back to 1977 [12]. Twenty two studies were from reference populations in North or South America, 17 from European countries, 8 from Asia, 1 from the Middle East, 1 from Australia and 1 from north Africa (Egypt).…”

Section: Resultsmentioning

confidence: 99%

“…Nine of the studies presented the reference data of volunteers [12,14,22,36-41]. There were two studies sampling reference participants from wards [38,42], two studies sampled participants from a database(s) [43,44] and one study reported reference values of normal control group [13].…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 summarizes the sample characteristics of all 51 included studies [6,8,9,12-33,35-60]. As the right heart examination should include a measure of the right atrial (RA) and RV size and structure, RV systolic function and pulmonary artery (PA) pressures, [1] our findings are presented in Table 2 (published reference data for right heart size/volume), Table 3 (published reference data for right heart morphology), Tables 4, 5, and 6 (published reference data for RV- and valve function),and Table 7 (published reference data for right heart haemodynamics).…”

Section: Resultsmentioning

confidence: 99%

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Reference intervals for the echocardiographic measurements of the right heart in children and adolescents: a systematic review

Lemmer

Engel

Stanfliet

et al. 2014

Cardiovasc Ultrasound

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BackgroundTransthoracic echocardiography is the primary imaging modality for the diagnosis of right ventricular (RV) involvement in congenital and acquired heart diseases. There is increasing recognition of the contribution of RV dysfunction in heart diseases affecting children and adolescents, but there is insufficient information on reference intervals for the echocardiographic measurements of the right heart in children and adolescents that represent all the continental populations of the world.ObjectiveThe aim of this systematic review was to collate, from published studies, normative data for echocardiographic evaluation of the right heart in children and adolescents, and to identify gaps in knowledge in this field especially with respect to sub-Saharan Africans.MethodsWe performed a systematic literature search to identify studies of reference intervals for right heart measurements as determined by transthoracic echocardiography in healthy children and adolescents of school-going age. Articles were retrieved from electronic databases with a combination of search terms from the earliest date available until May 2013.ResultsReference data were available for a broad range of variables. Fifty one studies out of 3096 publications were included. The sample sizes of the reference populations ranged from 13 to 2036 with ages varying from 5 to 21 years. We identified areas lacking sufficient reference data. These included reference data for determining right atrial size, tricuspid valve area, RV dimensions and areas, the RV % fractional area change, pulmonary artery pressure gradients and the right-sided haemodynamics, including the inferior vena cava dimensions and collapsibility. There were no data for sub-Saharan African children and adolescents.ConclusionReliable reference data are lacking for important echocardiographic measurements of the RV in children and adolescents, especially for sub-Saharan Africans.

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“…' 6 For the assessment of the progression of the hypertrophy, thickness measurements obtained from M mode echocardiograms must be guided by cross sectional echocardiography, thus limiting the variability of these measurements. [26][27][28] Age, sex, familial incidence of hypertrophic cardiomyopathy, and medical treatment do not seem to influence the potential progression of hypertrophy. McKenna et al, using electrocardiography in a larger patient population, found not relation between these factors and the increase of electrocardiographic indices of left ventricular hypertrophy.…”

Section: Discussionmentioning

confidence: 98%

Progression of hypertrophic cardiomyopathy. A cross sectional echocardiographic study.

Domenicucci

Lazzeroni

Roelandt

et al. 1985

Heart

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SUMMARY The progression of hypertrophy was studied in 39 patients with hypertrophic cardiomyopathy by echocardiography at follow up from January 1979 to September 1983 (mean follow up 42 months). Thirty two patients were treated medically and 11 had had a septal myotomymyectomy. Progression of the hypertrophy was noted in four patients treated with propranolol. An additional region in the left ventricular long axis plane was affected in two, extending to the apical region in one and to the basal region in the other, and an additional segment in the left ventricular short axis plane in two extending from the septum into the free wall. The electrocardiograms of these four patients showed a significant increase in QRS voltages (Sokolow-Lyon index increase > 10 mm) and of the Romhilt-Estes score (increase -3 points) in two, development of a left bundle branch block in one, and no change in one. Progression of hypertrophy was seen in none of the 11 patients treated with myotomy-myectomy.Thus echocardiography accurately detects the progression of hypertrophy in patients with hypertrophic cardiomyopathy, which may be prevented by septal myotomy-myectomy.With echocardiography the familial occurrence of hypertrophic cardiomyopathy,' -3 its morphological4-6 and functional aspects,7-9 and the effects of medical' 0-1 2 and surgical treatment can be studied.'3 14Based on the patterns of distribution of the hypertrophy, classification into subtypes of hypertrophic cardiomyopathy has been proposed. I 16 The progression of hypertrophy has been assessed in patients by electrocardiography,'7 but because of its low sensitivity and specificity in detecting hypertrophy in these patients'8 this method may not be useful for studying its progression. The aim of this study was to investigate by serial electrocardiography and cross sectional echocardiography whether or not progression of hypertrophy occurs in hypertrophic cardiomyopathy. Patients and methods STUDY GROUPSTwo groups of patients with hypertrophic car-

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Interobserver variability in echocardiography

Cited by 45 publications

References 16 publications

Detection of hypertensive left ventricular hypertrophy.

Detection of hypertensive left ventricular hypertrophy.

Reference intervals for the echocardiographic measurements of the right heart in children and adolescents: a systematic review

Progression of hypertrophic cardiomyopathy. A cross sectional echocardiographic study.

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