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Reliability and Identification of Aortic Valve Prolapse in the Horse

, 1 , 1

BMC Veterinary Research

BioMed Central

Cardiology, Equine, Echocardiography, Repeatability, Reproducibility

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      Abstract

      Background

      The objectives were to determine and assess the reliability of criteria for identification of aortic valve prolapse (AVP) using echocardiography in the horse.

      Results

      Opinion of equine cardiologists indicated that a long-axis view of the aortic valve (AoV) was most commonly used for identification of AVP (46%; n=13). There was consensus that AVP could be mimicked by ultrasound probe malignment. This was confirmed in 7 healthy horses, where the appearance of AVP could be induced by malalignment. In a study of a further 8 healthy horses (5 with AVP) examined daily for 5 days, by two echocardiographers standardized imaging guidelines gave good to excellent agreement for the assessment of AVP (kappa>0.80) and good agreement between days and observers (kappa >0.6). The technique allowed for assessment of the degree of prolapse and measurement of the prolapse distance that provided excellent agreement between echocardiographers, days and observers (kappa/ICC>0.8). Assessments made using real-time zoomed images provided similar measurements to the standard views (ICC=0.9), with agreement for the identification of AVP (kappa>0.8).

      Short axis views of the AoV were used for identification of AVP by fewer respondents (23%), however provided less agreement for the identification of AVP (kappa>0.6) and only adequate agreement with observations made in long axis (kappa>0.5), with AVP being identified more often in short axis (92%) compared to long axis (76%).

      Orthogonal views were used by 31% of respondents to identify the presence of AVP, and 85% to identify cusp. Its identification on both views on 4 days was used to categorise horses as having AVP, providing a positive predictive value of 79% and negative predictive value of 18%. Only the non-coronary cusp (NCC) of the AoV was observed to prolapse in these studies. Prolapse of the NCC was confirmed during the optimisation study using four-dimensional echocardiography, which concurred with the findings of two-dimensional echocardiography.

      Conclusions

      This study has demonstrated reliable diagnostic criteria for the identification and assessment of AVP that can be used for longitudinal research studies to better define the prevalence and natural history of this condition.

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      Most cited references 25

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      The measurement of observer agreement for categorical data.

       G Koch,  J R Landis (1977)
      This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
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        • Record: found
        • Abstract: not found
        • Article: not found

        The measurement of observer agreement for categorical data

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          • Record: found
          • Abstract: not found
          • Article: not found

          The measurement of observer agreement for categorical data

           JR Landis,  GG Koch (1977)
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            Author and article information

            Affiliations
            [1 ]School of Veterinary Medicine and Science (SVMS), University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Leicestershire, LE12 5RD, UK
            Contributors
            Journal
            BMC Vet Res
            BMC Vet. Res
            BMC Veterinary Research
            BioMed Central
            1746-6148
            2013
            11 January 2013
            : 9
            : 9
            23311963
            3547808
            1746-6148-9-9
            10.1186/1746-6148-9-9
            Copyright ©2013 Hallowell and Bowen; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Research Article

            Veterinary medicine

            cardiology, reproducibility, repeatability, echocardiography, equine

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