A quality control exercise in the echo laboratory: Reduction in inter-observer variability in the interpretation of pulmonary hypertension.

BACKGROUND: Right ventricular systolic pressure (RVSP) estimated by echocardiography is critical for the initial screening and follow-up of pulmonary hypertension (PH). Inter-observer variability (IOV) in RVSP can impact clinical decision making. This study assessed whether a simple guideline-based teaching intervention could reduce the IOV in RVSP interpretation.

METHODS AND RESULTS: Eleven participants in a high-volume tertiary level echocardiography laboratory underwent an assessment of the baseline IOV in the assessment of RVSP for a series of transthoracic echocardiograms (TTE), depicting various degrees of PH among 8 cases each before and after a teaching intervention. The inter-observer variance (root-mean-square error) decreased from 26.0 mm Hg2 (5.1 mm Hg) at baseline to 5.8 mm Hg2 (2.4 mm Hg) post-teaching intervention (P = .025). The corresponding inter-class coefficient (ICC) increased from 0.89 to 0.98. Several factors relating to image acquisition and interpretation were identified as contributing to IOV in RVSP. The outcome was the development of a practical tool to mitigate these factors.

CONCLUSIONS: A simple structured teaching intervention successfully reduced IOV in the measurement of RVSP in a high-volume echo laboratory.