Abstract
PurposeThis study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork.MethodsAll participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S’), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e’) and left ventricular ejection fraction (LVEF) were measured.ResultsThe accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was > 0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S’ = 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%.ConclusionsWhen performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.
Highlights
Exercise Doppler echocardiography (EDE) is standard practice for the evaluation of patients with coronary artery disease
Inter-observer variability for resting and exercise variables was for tricuspid regurgitation velocity (TRV) = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT velocity time integral (VTI) = 7.4 to 9.6%, S’ = 2.9 to 2.9% and tricuspid annular plane systolic excursion (TAPSE) = 5.3 to 8%
When performed in expert centers exercise Doppler echocardiography (EDE) is a reproducible tool for the assessment of the right heart and the pulmonary circulation
Summary
Exercise Doppler echocardiography (EDE) is standard practice for the evaluation of patients with coronary artery disease. Echocardiography of the right heart mainly relies on estimates of right chambers dimensions (diameters/areas/volumes) and function (i.e. fractional area change, tricuspid annular plane systolic excursion (TAPSE) and of tissue Doppler–derived tricuspid lateral annular systolic velocity (S’) [2, 3]. It estimates the components of the pulmonary vascular resistance equation, that is pulmonary artery pressure (PAP) from the maximum tricuspid regurgitation velocity (TRV), or the right ventricular outflow tract (RVOT) acceleration time (Act) of PA flow, wedged PAP from the ratio of transmitral flow E and mitral annulus e’ waves and cardiac output (CO) from the left ventricular outflow tract (LVOT) aortic flow. The present report aims to provide a quality control analysis of left, right heart and pulmonary circulation resting and EDE measurements among 19 echocardiography laboratories with proven experience participating in the RIGHT-NET study [6, 7]
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