Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension

ABSTRACT Background Echocardiographic evaluation of right heart (RH) size and function in horses is challenging and relies on subjective assessment. Objectives Evaluate inter‐ and intra‐rater agreement of subjective assessment of RH size, RH function, and the presence of pulmonary hypertension (PHT)...

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Main Authors: Julia N. vanSpijk, Hannah K. Junge, Christina Eberhardt, Natalie Wolf, Debora Vogt, Paula Zscherpe, Elena Herger, Manon Straub, Colin C. Schwarzwald
Format: Article
Language:English
Published: Wiley 2025-07-01
Series:Journal of Veterinary Internal Medicine
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Online Access:https://doi.org/10.1111/jvim.70145
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author Julia N. vanSpijk
Hannah K. Junge
Christina Eberhardt
Natalie Wolf
Debora Vogt
Paula Zscherpe
Elena Herger
Manon Straub
Colin C. Schwarzwald
author_facet Julia N. vanSpijk
Hannah K. Junge
Christina Eberhardt
Natalie Wolf
Debora Vogt
Paula Zscherpe
Elena Herger
Manon Straub
Colin C. Schwarzwald
author_sort Julia N. vanSpijk
collection DOAJ
description ABSTRACT Background Echocardiographic evaluation of right heart (RH) size and function in horses is challenging and relies on subjective assessment. Objectives Evaluate inter‐ and intra‐rater agreement of subjective assessment of RH size, RH function, and the presence of pulmonary hypertension (PHT) in horses. Assess subjective RH changes with and without PHT and the influence of observer experience. Animals Healthy horses (n = 30) and horses with Doppler measurements suggesting the presence or absence of PHT (n = 30 each). Methods Nine standard echocardiographic recordings were analyzed by experienced (n = 4) and inexperienced (n = 5) observers. RH size, RH function, pulmonary artery (PA) size and distensibility, and the presence of PHT were subjectively assessed as normal, mildly, moderately, or severely changed. Inter‐ and intra‐rater agreement was calculated using percentual agreement (% agree) and kappa (k). Sensitivity and specificity to detect PHT were calculated. Results Overall inter‐rater agreement in all observers was low with 61% perfect agreement and k of 0.21; it was higher in experienced observers (k = 0.34, 77% agree) than in beginners (k = 0.18, 52% agree). Intra‐rater agreement showed % agree > 80% in experienced observers (k = 0.35–0.76) and < 80% in beginners (k = 0.33–0.54). RH size and function were more commonly abnormal in the PHT group, with high specificity but low sensitivity to detect PHT. Conclusions and Clinical Importance Rater agreement of subjective RH assessment was low and influenced by observer experience. Subjective absence of RH changes does not allow ruling out PHT, while the presence of characteristic RH changes suggests PHT.
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spelling doaj-art-46f8807979004e8d89c0189abbafcd7c2025-08-20T03:09:35ZengWileyJournal of Veterinary Internal Medicine0891-66401939-16762025-07-01394n/an/a10.1111/jvim.70145Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary HypertensionJulia N. vanSpijk0Hannah K. Junge1Christina Eberhardt2Natalie Wolf3Debora Vogt4Paula Zscherpe5Elena Herger6Manon Straub7Colin C. Schwarzwald8Equine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandEquine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandDepartment of Companion Animal Clinical Studies, Faculty of Veterinary Science University of Pretoria Onderstepoort South AfricaEquine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandEquine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandEquine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandEquine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandEquine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandEquine Department University of Zurich, Vetsuisse Faculty Zurich SwitzerlandABSTRACT Background Echocardiographic evaluation of right heart (RH) size and function in horses is challenging and relies on subjective assessment. Objectives Evaluate inter‐ and intra‐rater agreement of subjective assessment of RH size, RH function, and the presence of pulmonary hypertension (PHT) in horses. Assess subjective RH changes with and without PHT and the influence of observer experience. Animals Healthy horses (n = 30) and horses with Doppler measurements suggesting the presence or absence of PHT (n = 30 each). Methods Nine standard echocardiographic recordings were analyzed by experienced (n = 4) and inexperienced (n = 5) observers. RH size, RH function, pulmonary artery (PA) size and distensibility, and the presence of PHT were subjectively assessed as normal, mildly, moderately, or severely changed. Inter‐ and intra‐rater agreement was calculated using percentual agreement (% agree) and kappa (k). Sensitivity and specificity to detect PHT were calculated. Results Overall inter‐rater agreement in all observers was low with 61% perfect agreement and k of 0.21; it was higher in experienced observers (k = 0.34, 77% agree) than in beginners (k = 0.18, 52% agree). Intra‐rater agreement showed % agree > 80% in experienced observers (k = 0.35–0.76) and < 80% in beginners (k = 0.33–0.54). RH size and function were more commonly abnormal in the PHT group, with high specificity but low sensitivity to detect PHT. Conclusions and Clinical Importance Rater agreement of subjective RH assessment was low and influenced by observer experience. Subjective absence of RH changes does not allow ruling out PHT, while the presence of characteristic RH changes suggests PHT.https://doi.org/10.1111/jvim.70145echocardiographypulmonary artery pressurerater agreementright ventricle
spellingShingle Julia N. vanSpijk
Hannah K. Junge
Christina Eberhardt
Natalie Wolf
Debora Vogt
Paula Zscherpe
Elena Herger
Manon Straub
Colin C. Schwarzwald
Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension
Journal of Veterinary Internal Medicine
echocardiography
pulmonary artery pressure
rater agreement
right ventricle
title Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension
title_full Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension
title_fullStr Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension
title_full_unstemmed Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension
title_short Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D‐Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension
title_sort evaluation of subjective assessment of right heart size and function using standard 2d echocardiographic recordings in horses with and without pulmonary hypertension
topic echocardiography
pulmonary artery pressure
rater agreement
right ventricle
url https://doi.org/10.1111/jvim.70145
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