Inter-rater and intra-rater reproducibility of the WHF criteria
| Echo features | Inter-rater reproducibility | Intra-rater reproducibility | ||
| Reliability Kappa mean (95% CI) | Proportion of agreement (95% CI) | Reliability Kappa median (IQR) | Proportion of agreement Median (IQR) | |
| RHD | ||||
| No vs borderline vs definite RHD | 0.49 (0.45 to 0.54) | 66.29% (63.14% to 69.44%) | 0.68 (0.60–0.72) | 74.75% (68.69%–80.81%) |
| Any RHD (definite or borderline) | 0.60 (0.55 to 0.65) | 80.04% (77.41% to 82.67%) | 0.65 (0.62–0.76) | 86.87% (84.85%–89.90%) |
| Definite RHD | 0.65 (0.59 to 0.70) | 82.27 % (79.54% to 84.99%) | 0.69 (0.61–0.72) | 86.87% (81.82%–88.89%) |
| Components of criteria | ||||
| Pathological MR | 0.79 (0.75 to 0.84) | 89.62% (87.39% to 91.84%) | 0.92 (0.88–0.94) | 95.96% (93.94%–96.97%) |
| Pathological AR | 0.86 (0.83 to 0.90) | 93.19% (91.28% to 95.10%) | 0.88 (0.85–0.93) | 95.96% (94.95%–97.98%) |
| >2 morphological features of MV | 0.57 (0.51 to 0.62) | 78.30 % (75.49% to 81.11%) | 0.62 (0.61–0.72) | 83.84% (81.82%–87.88%) |
| Mitral valve morphology | ||||
| Thickened AMVL | 0.75 (0.70 to 0.80) | 87.27% (84.83% to 89.72%) | 0.79 (0.78–0.85) | 89.9% (88.89%–92.93%) |
| Chordal thickening | 0.54 (0.49 to 0.59) | 76.78% (74.21% to 79.33%) | 0.37 (0.25–0.48) | 81.82% (77.78%–88.89%) |
| Restrictive motion | 0.55 (0.49 to 0.60) | 77.36% (74.64% to 80.01%) | 0.56 (0.33–0.62) | 83.84% (76.77%–86.87%) |
| Excessive leaflet motion | 0.63 (0.58 to 0.68) | 81.46% (79.01% to 83.90%) | 0.41 (0.22–0.48) | 88.89% (87.88%–92.93%) |
| Aortic valve | ||||
| Thickened | 0.67 (0.62 to 0.72) | 83.29% (80.85% to 85.72%) | 0.39 (0.24–0.51) | 90.91% (86.87%–94.95%) |
| Coaptation defect | 0.91 (0.88 to 0.94) | 95.43% (93.92% to 96.94%) | 0.56 (0.45–65) | 97.98% (95.96%–98.99%) |
| Restrictive motion | 0.97 (0.96 to 0.98) | 98.39% (97.73% to 99.01%) | 0.66 (Not Calculable) | 98.99% (97.98%–100%) |
| Prolapse | 0.93 (0.91 to 0.96) | 96.70% (95.36% to 98.04%) | 0.57 (0.45–1.0) | 98.99% (97.98%–100%) |
| Congenital heart disease | ||||
| MV prolapse disease | 0.92 (0.89 to 0,95) | 95.92% (94.47% to 97.38%) | 0.66 (0.65–0.85) | 97.98% (95.96%–98.99%) |
| Bicuspid AV | 0.95 (0.93 to 0.98) | 97.66% (96.41% to 98.91%) | 0.66 (0.65–0.89) | 98.99% (97.98%–98.99%) |
AMVL, anterior mitral valve leaflet; AR, aortic regurgitation; AV, aortic valve; MR, mitral regurgitation; MV, mitral valve; NC, not calculable; RHD, rheumatic heart disease; WHF, World Heart Federation.