A multicentric quality-control study of exercise Doppler
echocardiography of the right heart and the pulmonary circulation
Abstract
Purpose: This study was a quality-control study of resting and exercise
echocardiography (EDE) variables measured by 19 echocardiography
laboratories with proven experience participating in the RIGHT Heart
International NETwork. Methods: All participating investigators reported
the requested variables from ten randomly selected exercise stress
tests. Intraclass correlation coefficients (ICC) were calculated to
evaluate the inter-observer agreement with the core laboratory.
Inter-observer variability of resting and peak exercise tricuspid
regurgitation velocity (TRV), right ventricular outflow tract
acceleration time (RVOT Act), tricuspid annular plane systolic excursion
(TAPSE), tissue Doppler tricuspid lateral annular systolic velocity
(S’), right ventricular fractional area change (RV FAC), left
ventricular outflow tract velocity time integral (LVOT VTI), mitral
inflow pulsed wave Doppler velocity (E), diastolic mitral annular
velocity by TDI (e’) and left ventricular ejection fraction (LVEF) was
measured. Results: The accuracy of 19 investigators for all variables
ranged from 99.7% to 100%. ICC was > 0.80 for all
observers. Inter-observer variability for resting and exercise variables
was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act
= 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S’= 2.9 to 2.9% and TAPSE = 5.3
to 8%. Moderate inter-observer variability was found for resting and
peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak
exercise variability of 7.6 and 9%. Conclusions: When performed in
expert centers EDE is a reproducible tool for the assessment of the
right heart and the pulmonary circulation