Variability of echocardiographic measures of left ventricular diastolic function. The HUNT study

Objective Investigate variability related to image acquisition and reading process for echocardiographic measures of left ventricular (LV) diastolic function, and its influence on classification of LV diastolic dysfunction (LVDD). Methods Forty participants (19 women) mean age 62 (28-88) years underwent echocardiographic examinations twice by different echocardiographers and blinded analyses by four readers in a cross-sectional design. Measurements included quantification of two- (2D) and three-dimensional (3D) recordings of the left atrium (LA) (maximal) volume (LAV(max)) and spectral Doppler blood flow and tissue velocities for assessment of LV diastolic function. Variability and reproducibility measures were calculated using variance component analyses and Kappa statistics. Results Image acquisition influenced variability more than image reading (mean 24% and 4% of variance, respectively), but variability from image reading was especially important for 2D LAV(max) (16% of variance) compared to 4% for 3D LAV(max), which was reflected in better agreement for 3D measures. The variability of measures used in classification of LVDD had clinical significance, and agreement across the four raters in classification using current recommendations was only fair (Kappa 0.42), but the agreement improved when using 3D LAV(max) (Kappa 0.58). Agreement and reliability measures were reported for all measures. Conclusion Performing a new image acquisition influenced variability more than a introducing a new image reader, but there were differences across the different measures. LAV(max) by 3D is superior to 2D with respect to lower variability. The variability of diastolic measures influences the reliability of LVDD classification, and this should be taken into account in the everyday clinic.

Automated summary

The study found that image acquisition has a greater impact on variability in echocardiographic measures of left ventricular diastolic function than image reading, while different readers also contribute to variability. 3D measurements are superior to 2D measurements in reducing variability and are more important for classification of LVDD.