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Observer variation in the echocardiographic diagnosis of mitral valve prolapse

1986; Elsevier BV; Volume: 111; Issue: 6 Linguagem: Inglês

10.1016/0002-8703(86)90016-5

1097-6744

Martin Alpert, Robert J. Carney, Kirubakaran Munuswamy, Michael A. Ruder, Amarjeet S. Kapoor, Richard R. Webel, John F. Sanfelippo, Maged Haikal, Sharon K. Perkins, Diana L. Kelly,

Infective Endocarditis Diagnosis and Management

To assess inter- and intraobserver variation in the echocardiographic diagnosis of mitral valve prolapse, three independent observers analyzed M-mode echocardiograms (n = 80) and two-dimensional echocardiograms (n = 65) of patients with a mobile midsystolic click with or without a late or holosystolic murmur. In addition, a control group of 100 normal echocardiograms were interspersed among the echocardiograms of patients with mitral valve prolapse and were then interpreted. Each of the three observers analyzed all M-mode and two-dimensional echocardiograms initially and then 2 weeks later for the presence or absence of mitral valve prolapse. M-mode echocardiographic criteria for mitral valve prolapse consisted of late systolic posterior motion (≥ 3 mm) of one or both mitral leaflets or holosystolic hammocking (≥ 3 mm) of one or both mitral leaflets. Two-dimensional echocardiographic criteria for mitral valve prolapse consisted of: posterior systolic arching of one or both mitral leaflets in the parasternal long-axis view, and/or posterior systolic bowing of one or both mitral leaflets in the apical four-chamber view posterior to the plane of the mitral anulus, and/or excessive posterior coaptation of the mitral leaflets in either view flush with or posterior to the plane of the mitral anulus. There was insignificant observer variation both in the M-mode and two-dimensional echo groups, as determined using Cochran's Q test. The proportion of cases in the group with clinical mitral valve prolapse for which there was unanimous agreement was 81% and 78%, respectively, for the first and second readings for M-mode echocardiography, and 69% and 72% for the first and second readings, respectively, for two-dimensional echocardiography. Intraobserver repeatability for the first and second readings ranged from 89% to 96% for M-mode echocardiography and 77% to 86% for two-dimensional echocardiography. The data indicate that both echocardiographic modalities are associated with insignificant inter- and intraobserver variation in the diagnosis of mitral valve prolapse.