@article{e3e40dfe716d4b96a44f4b19172b7921,
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.}",
note = "Funding Information: 1Menzies School of Health Research, Casuarina, Northern Territory, Australia 2Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand 3Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia 4Paediatric and Congenital Cardiac Services, Starship Children{\textquoteright}s Hospital, Auckland, New Zealand 5Maputo HeartInstitute, Maputo, Mozambique 6Amrita Institute of Medical Sciences and Research Centre, Kochi, India 7Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa 8Department of Paediatrics and Child Health, Cape Town, South Africa 9Hop Europeen Georges Pompidou, Paris, France 10INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France 11Inst Coracao, New York City, New York, USA 12Federal University of Minas Gerais, Belo Horizonte, Brazil 13Cardiology, Project Health for Le{\'o}n, Raleigh, North Carolina, USA 14All India Institute of Medical Sciences, New Delhi, India 15Pediatric Cardiology, Children{\textquoteright}s National Health System, Washington, District of Columbia, USA 16Cardiology, Samoa National Hospital, Apia, Samoa 17Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, , India 18Cardiology, Women{\textquoteright}s and Children{\textquoteright}s Hospital, Adelaide, South Australia, Australia 19Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa 20Paediatric and Congenital Cardiology, Starship Children{\textquoteright}s Hospital, Auckland, New Zealand 21University of Auckland, Auckland, New Zealand Acknowledgements BR received a scholarship from Heart Foundation of New Zealand and from the Lowitja Institute of Australia. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
month = jun,
day = "1",
doi = "10.1136/heartasia-2019-011233",
language = "English",
volume = "11",
journal = "Heart Asia",
issn = "1759-1104",
number = "2",
}