RT Journal Article
SR Electronic
T1 Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria
JF Heart Asia
JO Heart Asia
FD BMJ Publishing Group Ltd, British Cardiovascular Society and Asia Pacific Heart Association
SP e011233
DO 10.1136/heartasia-2019-011233
VO 11
IS 2
A1 Bo Remenyi
A1 Jonathan Carapetis
A1 John W Stirling
A1 Beatrice Ferreira
A1 Krishnan Kumar
A1 John Lawrenson
A1 Eloi Marijon
A1 Mariana Mirabel
A1 A O Mocumbi
A1 Cleonice Mota
A1 John Paar
A1 Anita Saxena
A1 Janet Scheel
A1 Satu Viali
A1 I B Vijayalakshmi
A1 Gavin R Wheaton
A1 Liesl Zuhlke
A1 Karishma Sidhu
A1 Eliazar Dimalapang
A1 Thomas L Gentles
A1 Nigel J Wilson
YR 2019
UL http://heartasia.bmj.com/content/11/2/e011233.abstract
AB Objective Different definitions have been used for screening for rheumatic heart disease (RHD). This led to the development of the 2012 evidence-based World Heart Federation (WHF) echocardiographic criteria. The objective of this study is to determine the intra-rater and inter-rater reliability and agreement in differentiating no RHD from mild RHD using the WHF echocardiographic criteria.Methods A standard set of 200 echocardiograms was collated from prior population-based surveys and uploaded for blinded web-based reporting. Fifteen international cardiologists reported on and categorised each echocardiogram as no RHD, borderline or definite RHD. Intra-rater and inter-rater reliability was calculated using Cohen’s and Fleiss’ free-marginal multirater kappa (κ) statistics, respectively. Agreement assessment was expressed as percentages. Subanalyses assessed reproducibility and agreement parameters in detecting individual components of WHF criteria.Results Sample size from a statistical standpoint was 3000, based on repeated reporting of the 200 studies. The inter-rater and intra-rater reliability of diagnosing definite RHD was substantial with a kappa of 0.65 and 0.69, respectively. The diagnosis of pathological mitral and aortic regurgitation was reliable and almost perfect, kappa of 0.79 and 0.86, respectively. Agreement for morphological changes of RHD was variable ranging from 0.54 to 0.93 κ.Conclusions The WHF echocardiographic criteria enable reproducible categorisation of echocardiograms as definite RHD versus no or borderline RHD and hence it would be a suitable tool for screening and monitoring disease progression. The study highlights the strengths and limitations of the WHF echo criteria and provides a platform for future revisions.