Medical Journal of The Islamic Republic of Iran (MJIRI)
Iran University of Medical Sciences
Mon, Aug 17, 2026
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Volume 40, Issue 1 (1-2026)
Med J Islam Repub Iran 2026 |
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Mostafavi S, Nojoomizadeh L, Habibi H, Samanifard A, Panahi A, Bakhtiari S, et al . Interobserver Agreement in Transthoracic Echocardiography between Cardiology Residents and Attending Cardiologists: A Cross-Sectional Study. Med J Islam Repub Iran 2026; 40 (1) :645-661
URL: http://mjiri.iums.ac.ir/article-1-10287-en.html
URL: http://mjiri.iums.ac.ir/article-1-10287-en.html
Soroush Mostafavi 
, Leila Nojoomizadeh , Hamzeh Habibi , Arefeh Samanifard , Aynaz Panahi , Sara Bakhtiari , Abdolfattah Mohtashami , Seyede Saba Mostafavi Montazeri , Seyedeh Sarvin Mostafavi Montazeri , Pegah Joghataie , Mahboubeh Pazoki
, Leila Nojoomizadeh , Hamzeh Habibi , Arefeh Samanifard , Aynaz Panahi , Sara Bakhtiari , Abdolfattah Mohtashami , Seyede Saba Mostafavi Montazeri , Seyedeh Sarvin Mostafavi Montazeri , Pegah Joghataie , Mahboubeh Pazoki
Department of Cardiology, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran , pazoki.m@IUMS.ac.ir
Abstract: (142 Views)
Background: Transthoracic echocardiography (TTE) is essential for making clinical decisions regarding cardiovascular disorders. Cardiology trainees frequently conduct and interpret TTE examinations; however, discrepancies between their interpretations and those of attending cardiologists can impact patient management. The objective of this study was to assess the concordance between cardiology trainees and attending cardiologists in the interpretation of TTE findings.
Methods: This study included 374 inpatients and outpatients referred to for TTE examinations. TTE studies were independently performed by second- and third-year cardiology residents, followed by reassessment by fellowship-trained attending cardiologists. The agreement of categorical variables was analyzed using Cohen’s kappa coefficient, while the agreement of quantitative parameters was determined by the intraclass correlation coefficient (ICC).
Results: There was good to excellent agreement between residents and attending evaluators for most parameters, including Pericardial Effusion (PE) (κ = 0.929), Inferior Vena Cava (IVC) (κ = 0.919), and Mitral Valve Prolapse (MVP) (κ = 0.908). Moderate agreement was observed for Atrial Septal Defect (ASD) (κ = 0.496) and Bicuspid Aortic Valve (κ = 0.565). Quantitative measures demonstrated excellent reliability for Left Ventricular Ejection Fraction (LVEF) (ICC = 0.949), Pulmonary Artery Pressure (PAP) (ICC = 0.981), Tricuspid Annular Plane Systolic Excursion (TAPSE) (ICC = 0.984), and Tricuspid Regurgitation Gradient (TRG) (ICC = 0.975).
Conclusion: Majority of the echocardiographic indices were interpreted reliably by the cardiologists-in-training. However, lower levels of agreement in the interpretation of ASD and aortic valve morphology indicate that additional training on structurally complex cardiac conditions is necessary to enhance the reliability of interpretations.
Methods: This study included 374 inpatients and outpatients referred to for TTE examinations. TTE studies were independently performed by second- and third-year cardiology residents, followed by reassessment by fellowship-trained attending cardiologists. The agreement of categorical variables was analyzed using Cohen’s kappa coefficient, while the agreement of quantitative parameters was determined by the intraclass correlation coefficient (ICC).
Results: There was good to excellent agreement between residents and attending evaluators for most parameters, including Pericardial Effusion (PE) (κ = 0.929), Inferior Vena Cava (IVC) (κ = 0.919), and Mitral Valve Prolapse (MVP) (κ = 0.908). Moderate agreement was observed for Atrial Septal Defect (ASD) (κ = 0.496) and Bicuspid Aortic Valve (κ = 0.565). Quantitative measures demonstrated excellent reliability for Left Ventricular Ejection Fraction (LVEF) (ICC = 0.949), Pulmonary Artery Pressure (PAP) (ICC = 0.981), Tricuspid Annular Plane Systolic Excursion (TAPSE) (ICC = 0.984), and Tricuspid Regurgitation Gradient (TRG) (ICC = 0.975).
Conclusion: Majority of the echocardiographic indices were interpreted reliably by the cardiologists-in-training. However, lower levels of agreement in the interpretation of ASD and aortic valve morphology indicate that additional training on structurally complex cardiac conditions is necessary to enhance the reliability of interpretations.
Keywords: Transthoracic Echocardiography, Echocardiography Training, Cardiology Residents, Interobserver Agreement, Intraclass Correlation Coefficient, Cohen’s Kappa
: Original Research |
Subject:
Medical Education
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