Reproducibility in Echocardiographic Assessment of Diastolic Function in a Population Based Study (The STANISLAS Cohort Study)

• Published in: PloS one Vol. 10; no. 4; p. e0122336
• Main Authors: Frikha, Zied, Girerd, Nicolas, Huttin, Olivier, Courand, Pierre Yves, Bozec, Erwan, Olivier, Arnaud, Lamiral, Zohra, Zannad, Faiez, Rossignol, Patrick
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.04.2015; Public Library of Science (PLoS)
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Antihypertensives; Blood Flow Velocity - physiology; Blood pressure; Body mass; Body weight; Cardiology and cardiovascular system; Cohort analysis; Cohort Studies; Correlation analysis; Correlation coefficient; Correlation coefficients; Diagnosis; Diastole - physiology; Doppler effect; Drugs; Echocardiography; Female; France; Heart; Heart Failure - diagnosis; Heart Failure - physiopathology; Human health and pathology; Humans; Hypertension; Hypertension - drug therapy; Hypertension - physiopathology; Life Sciences; Male; Measurement; Middle Aged; Overweight; Population studies; Population-based studies; Reproducibility; Sinus; Smoking; Ventricle; Ventricular Function, Left - physiology; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0122336

There is limited evidence regarding intra-observer and inter-observer variations in echocardiographic measurements of diastolic function. This study aimed to assess this reproducibly within a population-based cohort study. Sixty subjects in sinus rhythm were randomly selected among 4th visit participants of the STANISLAS Cohort (Lorraine region, France). This 4th examination systematically included M-mode, 2-dimensional, DTI and pulsed-wave Doppler echocardiograms. Reproducibility of variables was studied by intra-class correlation coefficients (ICC) and Bland Altman plots. Our population was on average middle-aged (50 ± 14 y), overweight (BMI = 26 ± 6 kg/m2) and non-smoking (87%) with a quarter of the participants having self-declared hypertension or treated with anti-hypertensive medication(s). Intra-observer ICC were > 0.90 for all analyzed parameters except for left ventricular ejection fraction (LVEF) which was 0.89 (0.81-0.93). The mean relative intra-observer differences were small and limits of agreement of relative differences were narrow for all considered parameters (<5% and <15% respectively). Inter-observer ICC were > 0.90 for all analyzed parameters except for LVEF (ICC = 0.87) and both mitral and pulmonary A wave duration (0.83 and 0.73 respectively). The mean relative inter-observer differences were <5% for all parameters except for pulmonary A wave duration (mean difference = 6.5%). Limits of agreement of relative differences were narrow (<15%), except for mitral A wave duration and velocity (both <20%) as well as left ventricular mass and pulmonary A wave duration (both <30%). Intra-observer agreements with regard to the presence and severity of diastolic dysfunction were excellent (Kappa = 0.93 (0.83-1.00) and 0.88 (0.75-0.99), respectively). In this validation study within the STANISLAS cohort, diastolic function echocardiographic parameters were found to be highly reproducible. Diastolic dysfunction consequently appears as a highly effective clinical and research tool.