HIGH REPRODUCIBILITY IN THE INTERPRETATION OF INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC EVALUATION OF AORTIC ATHEROMATOUS DISEASE

Intraoperative decisions are often based on interpretation of results from transesophageal echocardiography (TEE). One such area is the intr aoperative evaluation of atheromatous disease of the thoracic aorta an d subsequent classification or grading. These grading schemes are pred ictive of stroke after cardiac surgery. Since intraoperative strategie s may be modified based on this TEE aortic atheroma grading, assessmen t of the interobserver variability of TEE findings between observers i s essential. Forty TEE videotape segments imaging three portions of th e thoracic aorta (ascending, arch, descending) were selected from 189 reports of a larger cohort. Three independent, blinded observers, expe rienced in TEE, evaluated these examinations for atheroma severity. If a TEE segment had insufficient data, ''uninterpretable'' was recorded . Weighted kappa coefficients of agreement were calculated on the thre e data sets. Mean weighted kappa coefficients for the three observers A, B, and C were 0.69, 0.74, and 0.72, for the ascending, arch, and de scending aorta segments, respectively, representing excellent agreemen t. We have demonstrated uniformly high agreement for interpretation of TEE, which indicates the excellent reproducibility of TEE grading and stratification of aortic atheroma. Reproducibility within and across specialties and institutions is essential for widespread application o f TEE for evaluation of the thoracic aorta.