INTEROBSERVER VARIABILITY IN THE DETECTION OF SPONTANEOUS ECHO CONTRAST, LEFT ATRIAL THROMBI, AND LEFT ATRIAL APPENDAGE THROMBI BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Objective-To assess the interobserver variability between two observer s from different echocardiographic laboratories. Design-Two observers reviewed video recordings blinded to the other's diagnosis. In part I (n = 88), they determined interobserver variability for spontaneous ec ho contrast, left atrial thrombi, and appendage thrombi. No diagnostic criteria for thrombi were defined. In part II (n = 85), diagnostic cr iteria for thrombi were defined. Results-Part I: Both observers agreed in diagnosing spontaneous echo contrast in 97%, left atrial thrombi i n 90%, left atrial appendage thrombi in 94%. Part II: With predefined criteria no disagreement occurred in diagnosing left atrial thrombi. I n the diagnosis of left atrial appendage thrombi both observers agreed in 89%. The mean diameters of the 10 thrombi on which the observers a greed were greater than of the nine appendage thrombi on which they di sagreed. Conclusions-Interobserver variability in the diagnosis of spo ntaneous echo contrast is low. Defined criteria decrease interobserver variability for left atrial and appendage thrombi, although one third of the thrombi diagnosed by one observer were not confirmed by the ot her. Interobserver variability is high in the assessment of small stru ctures (<15 mm) within the left atrial appendage.