Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria

Bo Remenyi, Jonathan Carapetis, John W. Stirling, Beatrice Ferreira, Krishnan Kumar, John Lawrenson, Eloi Marijon, Mariana Mirabel, A. O. Mocumbi, Cleonice Mota, John Paar, Anita Saxena, Janet Scheel, Satu Viali, I. B. Vijayalakshmi, Gavin R. Wheaton, Liesl Zuhlke, Karishma Sidhu, Eliazar Dimalapang, Thomas L. Gentles & 1 others Nigel J. Wilson

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Abstract

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.

Original languageEnglish
Article numbere011233
Pages (from-to)1-8
Number of pages8
JournalHeart Asia
Volume11
Issue number2
DOIs
Publication statusPublished - 24 Jun 2019

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Rheumatic Heart Disease
Aortic Valve Insufficiency
Mitral Valve Insufficiency
Sample Size
Disease Progression

Cite this

Remenyi, Bo ; Carapetis, Jonathan ; Stirling, John W. ; Ferreira, Beatrice ; Kumar, Krishnan ; Lawrenson, John ; Marijon, Eloi ; Mirabel, Mariana ; Mocumbi, A. O. ; Mota, Cleonice ; Paar, John ; Saxena, Anita ; Scheel, Janet ; Viali, Satu ; Vijayalakshmi, I. B. ; Wheaton, Gavin R. ; Zuhlke, Liesl ; Sidhu, Karishma ; Dimalapang, Eliazar ; Gentles, Thomas L. ; Wilson, Nigel J. / Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria. In: Heart Asia. 2019 ; Vol. 11, No. 2. pp. 1-8.
@article{8ce05acf5a674c8bad3a719e6244593c,
title = "Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria",
abstract = "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.",
keywords = "aortic valve disease, mitral regurgitation, paediatric echocardiography, rheumatic fever",
author = "Bo Remenyi and Jonathan Carapetis and Stirling, {John W.} and Beatrice Ferreira and Krishnan Kumar and John Lawrenson and Eloi Marijon and Mariana Mirabel and Mocumbi, {A. O.} and Cleonice Mota and John Paar and Anita Saxena and Janet Scheel and Satu Viali and Vijayalakshmi, {I. B.} and Wheaton, {Gavin R.} and Liesl Zuhlke and Karishma Sidhu and Eliazar Dimalapang and Gentles, {Thomas L.} and Wilson, {Nigel J.}",
year = "2019",
month = "6",
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doi = "10.1136/heartasia-2019-011233",
language = "English",
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pages = "1--8",
journal = "Heart Asia",
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Remenyi, B, Carapetis, J, Stirling, JW, Ferreira, B, Kumar, K, Lawrenson, J, Marijon, E, Mirabel, M, Mocumbi, AO, Mota, C, Paar, J, Saxena, A, Scheel, J, Viali, S, Vijayalakshmi, IB, Wheaton, GR, Zuhlke, L, Sidhu, K, Dimalapang, E, Gentles, TL & Wilson, NJ 2019, 'Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria', Heart Asia, vol. 11, no. 2, e011233, pp. 1-8. https://doi.org/10.1136/heartasia-2019-011233

Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria. / Remenyi, Bo; Carapetis, Jonathan; Stirling, John W.; Ferreira, Beatrice; Kumar, Krishnan; Lawrenson, John; Marijon, Eloi; Mirabel, Mariana; Mocumbi, A. O.; Mota, Cleonice; Paar, John; Saxena, Anita; Scheel, Janet; Viali, Satu; Vijayalakshmi, I. B.; Wheaton, Gavin R.; Zuhlke, Liesl; Sidhu, Karishma; Dimalapang, Eliazar; Gentles, Thomas L.; Wilson, Nigel J.

In: Heart Asia, Vol. 11, No. 2, e011233, 24.06.2019, p. 1-8.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria

AU - Remenyi, Bo

AU - Carapetis, Jonathan

AU - Stirling, John W.

AU - Ferreira, Beatrice

AU - Kumar, Krishnan

AU - Lawrenson, John

AU - Marijon, Eloi

AU - Mirabel, Mariana

AU - Mocumbi, A. O.

AU - Mota, Cleonice

AU - Paar, John

AU - Saxena, Anita

AU - Scheel, Janet

AU - Viali, Satu

AU - Vijayalakshmi, I. B.

AU - Wheaton, Gavin R.

AU - Zuhlke, Liesl

AU - Sidhu, Karishma

AU - Dimalapang, Eliazar

AU - Gentles, Thomas L.

AU - Wilson, Nigel J.

PY - 2019/6/24

Y1 - 2019/6/24

N2 - 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.

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.

KW - aortic valve disease

KW - mitral regurgitation

KW - paediatric echocardiography

KW - rheumatic fever

UR - http://www.scopus.com/inward/record.url?scp=85068190993&partnerID=8YFLogxK

U2 - 10.1136/heartasia-2019-011233

DO - 10.1136/heartasia-2019-011233

M3 - Article

VL - 11

SP - 1

EP - 8

JO - Heart Asia

JF - Heart Asia

SN - 1759-1104

IS - 2

M1 - e011233

ER -