OBSERVER VARIATION IN THE TWO‐DIMENSIONAL ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE PROLAPSE IN DOGS

Abstract

In this study, the observer variation and the influence of observer experience in diagnosing mitral valve prolapse in dogs was assessed by having three observers with different degrees of echocardiographic experience (10 years, 4 years, and no prior experience) analyze 303 mitral valve video recordings from 253 dogs, both with and without mitral regurgitation. To assess intraobserver variation, 16 recordings were analyzed twice, and 34 dogs were scanned twice at intervals of a few days. By consensus, 90 dogs had no mitral valve prolapse, 130 had mild and 33 had severe mitral valve prolapse. Intraobserver repeatabilities ranged from 88% to 100% and interobserver repeatabilities from 70% to 78%. In 79% to 94% of the dogs that were scanned twice, the observers diagnosed both recordings identically. All repeatabilities were reduced by approximately 10% when mitral valve prolapse was graded into mild and severe. The three observers differed significantly in diagnosing mitral valve prolapse when compared with each other in pairs (all p‐values < 0.01). The unexperienced observer had the highest and most unsystematic occurrence of false diagnoses. It is possible that the interobserver repeatabilities would have been lower had each sonographer obtained his own echocardiograms. We conclude, that mitral valve prolapse in dogs can be diagnosed using two‐dimensional echocardiography with the same degree of observer variation as reported in human studies, and that education and training of staff is mandatory to ensure proper ultrasonographic evaluation.