Abstract
OBJECTIVE--To assess the interobserver variability between two observers from different echocardiographic laboratories. DESIGN--Two observers reviewed video recordings blinded to the other's diagnosis. In part I (n = 88), they determined interobserver variability for spontaneous echo contrast, left atrial thrombi, and appendage thrombi. No diagnostic criteria for thrombi were defined. In part II (n = 85), diagnostic criteria for thrombi were defined. RESULTS--Part I: Both observers agreed in diagnosing spontaneous echo contrast in 97%, left atrial thrombi in 90%, left atrial appendage thrombi in 94%. Part II: With predefined criteria no disagreement occurred in diagnosing left atrial thrombi. In the diagnosis of left atrial appendage thrombi both observers agreed in 89%. The mean diameters of the 10 thrombi on which the observers agreed were greater than of the nine appendage thrombi on which they disagreed. CONCLUSIONS--Interobserver variability in the diagnosis of spontaneous echo contrast is low. Defined criteria decrease interobserver variability for left atrial and appendage thrombi, although one third of the thrombi diagnosed by one observer were not confirmed by the other. Interobserver variability is high in the assessment of small structures (< 15 mm) within the left atrial appendage.
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- Acar J., Cormier B., Grimberg D., Kawthekar G., Iung B., Scheuer B., Farah E. Diagnosis of left atrial thrombi in mitral stenosis--usefulness of ultrasound techniques compared with other methods. Eur Heart J. 1991 Jul;12 (Suppl B):70–76. doi: 10.1093/eurheartj/12.suppl_b.70. [DOI] [PubMed] [Google Scholar]
- Aschenberg W., Schlüter M., Kremer P., Schröder E., Siglow V., Bleifeld W. Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus. J Am Coll Cardiol. 1986 Jan;7(1):163–166. doi: 10.1016/s0735-1097(86)80275-3. [DOI] [PubMed] [Google Scholar]
- Beppu S., Nimura Y., Sakakibara H., Nagata S., Park Y. D., Izumi S. Smoke-like echo in the left atrial cavity in mitral valve disease: its features and significance. J Am Coll Cardiol. 1985 Oct;6(4):744–749. doi: 10.1016/s0735-1097(85)80476-9. [DOI] [PubMed] [Google Scholar]
- Daniel W. G., Nellessen U., Schröder E., Nonnast-Daniel B., Bednarski P., Nikutta P., Lichtlen P. R. Left atrial spontaneous echo contrast in mitral valve disease: an indicator for an increased thromboembolic risk. J Am Coll Cardiol. 1988 Jun;11(6):1204–1211. doi: 10.1016/0735-1097(88)90283-5. [DOI] [PubMed] [Google Scholar]
- Erbel R., Stern H., Ehrenthal W., Schreiner G., Treese N., Krämer G., Thelen M., Schweizer P., Meyer J. Detection of spontaneous echocardiographic contrast within the left atrium by transesophageal echocardiography: spontaneous echocardiographic contrast. Clin Cardiol. 1986 Jun;9(6):245–252. doi: 10.1002/clc.4960090603. [DOI] [PubMed] [Google Scholar]
- Hwang J. J., Chen J. J., Lin S. C., Tseng Y. Z., Kuan P., Lien W. P., Lin F. Y., Chu S. H., Hung C. R., How S. W. Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations. Am J Cardiol. 1993 Sep 15;72(9):677–681. doi: 10.1016/0002-9149(93)90884-f. [DOI] [PubMed] [Google Scholar]
- Lin S. L., Hsu T. L., Liou J. Y., Chen C. H., Chang M. S., Chiang H. T., Chen C. Y. Usefulness of transesophageal echocardiography for the detection of left atrial thrombi in patients with rheumatic heart disease. Echocardiography. 1992 Mar;9(2):161–168. doi: 10.1111/j.1540-8175.1992.tb00454.x. [DOI] [PubMed] [Google Scholar]
- Olson J. D., Goldenberg I. F., Pedersen W., Brandt D., Kane M., Daniel J. A., Nelson R. R., Mooney M. R., Lange H. W. Exclusion of atrial thrombus by transesophageal echocardiography. J Am Soc Echocardiogr. 1992 Jan-Feb;5(1):52–56. doi: 10.1016/s0894-7317(14)80103-x. [DOI] [PubMed] [Google Scholar]
- Shrestha N. K., Moreno F. L., Narciso F. V., Torres L., Calleja H. B. Two-dimensional echocardiographic diagnosis of left-atrial thrombus in rheumatic heart disease. A clinicopathologic study. Circulation. 1983 Feb;67(2):341–347. doi: 10.1161/01.cir.67.2.341. [DOI] [PubMed] [Google Scholar]
- Tsai L. M., Chen J. H., Fang C. J., Lin L. J., Kwan C. M. Clinical implications of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation. Am J Cardiol. 1992 Aug 1;70(3):327–331. doi: 10.1016/0002-9149(92)90613-4. [DOI] [PubMed] [Google Scholar]