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Abstract：
In 2012, the World Heart Federation (WHF) published guidelines for the echocardiographic diagnosis of rheumatic heart disease (RHD). This study assesses individual reviewer performance and inter-rater agreement and reliability on the presence of any RHD, as well classification of RHD based on the 2012 WHF criteria.
Four cardiologists individually reviewed echocardiograms in the context of a randomized clinical trial (ClinicalTrials.gov:NCT03346525) and participated in a blinded adjudication panel. Panel decision was the reference standard for diagnosis. Performance of individual reviewers to panel adjudication was compared through sensitivity and specificity analyses and inter-rater reliability was assessed between individual panelists using Fleiss free marginal multirater kappa.
Echocardiograms from 784 children had two independent reports and panel adjudication. The accuracy of independent reviewers for any RHD had high sensitivity (94%, 95% CI 93-95%) and moderate specificity (62%, 95% CI 53-70%). Sensitivity and specificity for definite RHD was 61.3 (95% CI, 55.3-67.1) and 93.1 (95% CI, 91.6-94.4), with 86.8 (84.7-88.7) and 65.8 (61.0-70.4) for borderline RHD. There was moderate inter-rater agreement (κ = 0.66) on the presence of any RHD while agreement for specific 2012 WHF classification was only fair (κ = 0.51).
The 2012 WHF guidelines are moderately reproducible when used by expert cardiologists. More cases of RHD were diagnosed by an consensus panel than by individual reviewers. A revision to the criteria is now warranted to further increase the reliability of the WHF criteria.
Four cardiologists individually reviewed echocardiograms in the context of a randomized clinical trial (ClinicalTrials.gov:NCT03346525) and participated in a blinded adjudication panel. Panel decision was the reference standard for diagnosis. Performance of individual reviewers to panel adjudication was compared through sensitivity and specificity analyses and inter-rater reliability was assessed between individual panelists using Fleiss free marginal multirater kappa.
Echocardiograms from 784 children had two independent reports and panel adjudication. The accuracy of independent reviewers for any RHD had high sensitivity (94%, 95% CI 93-95%) and moderate specificity (62%, 95% CI 53-70%). Sensitivity and specificity for definite RHD was 61.3 (95% CI, 55.3-67.1) and 93.1 (95% CI, 91.6-94.4), with 86.8 (84.7-88.7) and 65.8 (61.0-70.4) for borderline RHD. There was moderate inter-rater agreement (κ = 0.66) on the presence of any RHD while agreement for specific 2012 WHF classification was only fair (κ = 0.51).
The 2012 WHF guidelines are moderately reproducible when used by expert cardiologists. More cases of RHD were diagnosed by an consensus panel than by individual reviewers. A revision to the criteria is now warranted to further increase the reliability of the WHF criteria.
摘要：
2012年，世界心脏联合会（WHF）发布了风湿性心脏病（RHD）的超声心动图诊断指南。本研究评估了单个审阅者的表现以及评估者之间关于任何RHD存在的协议和可靠性，以及基于2012年WHF标准的RHD分类。
四位心脏病专家在一项随机临床试验（ClinicalTrials.gov：NCT03346525）的背景下单独审查了超声心动图，并参加了一个盲法裁决小组。小组决定是诊断的参考标准。通过敏感性和特异性分析比较了单个审阅者对小组裁决的表现，并使用Fleissfree边际多评估者kappa评估了单个小组成员之间的评估者间可靠性。
784名儿童的超声心动图有两份独立报告和小组裁决。独立审稿人对任何RHD的准确性都有很高的敏感度(94%，95%CI93-95%)和中等特异性(62%，95%CI53-70%）。明确RHD的敏感性和特异性为61.3（95％CI，55.3-67.1）和93.1（95％CI，91.6-94.4），临界RHD为86.8（84.7-88.7）和65.8（61.0-70.4）。对于任何RHD的存在，评分者之间存在适度的共识（κ=0.66），而对于特定的2012年WHF分类的共识仅是公平的（κ=0.51）。
心脏病专家使用2012年WHF指南时，具有中等可重复性。由共识小组诊断的RHD病例比由个人审阅者更多。现在有必要对标准进行修订，以进一步提高WHF标准的可靠性。
四位心脏病专家在一项随机临床试验（ClinicalTrials.gov：NCT03346525）的背景下单独审查了超声心动图，并参加了一个盲法裁决小组。小组决定是诊断的参考标准。通过敏感性和特异性分析比较了单个审阅者对小组裁决的表现，并使用Fleissfree边际多评估者kappa评估了单个小组成员之间的评估者间可靠性。
784名儿童的超声心动图有两份独立报告和小组裁决。独立审稿人对任何RHD的准确性都有很高的敏感度(94%，95%CI93-95%)和中等特异性(62%，95%CI53-70%）。明确RHD的敏感性和特异性为61.3（95％CI，55.3-67.1）和93.1（95％CI，91.6-94.4），临界RHD为86.8（84.7-88.7）和65.8（61.0-70.4）。对于任何RHD的存在，评分者之间存在适度的共识（κ=0.66），而对于特定的2012年WHF分类的共识仅是公平的（κ=0.51）。
心脏病专家使用2012年WHF指南时，具有中等可重复性。由共识小组诊断的RHD病例比由个人审阅者更多。现在有必要对标准进行修订，以进一步提高WHF标准的可靠性。
