Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D-Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension.
Abstract: Echocardiographic evaluation of right heart (RH) size and function in horses is challenging and relies on subjective assessment. Objective: 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. Methods: 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: 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.
© 2025 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Publication Date: 2025-07-01 PubMed ID: 40586330PubMed Central: PMC12207654DOI: 10.1111/jvim.70145Google Scholar: Lookup
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Summary
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This research investigates the accuracy of subjective assessment using 2D-echocardiographic recordings to evaluate heart size, function, and potential presence of pulmonary hypertension in horses. The study found that the reliability of these assessments relies heavily on the experience level of observers and that while presence of right heart changes is indicative of pulmonary hypertension, its absence doesn’t conclusively rule out the condition.
Objective and Methodology of the Study
- The study aimed to assess the agreement between observers when evaluating right heart (RH) size, function, and the presence of pulmonary hypertension (PHT) in horses by subjective assessment using standard 2D-echocardiographic recordings.
- In order to determine if the assessments are reliable or vary according to experience, the researchers studied observations from both expert observers with prior experience (four individuals) and beginners with little to no experience (five individuals).
- A total of 60 horses were used in the study, half of which were healthy and the other half of which had Doppler measurements indicating the presence or absence of PHT.
- For the purpose of evaluation, RH size, RH function, size and flexibility of the pulmonary artery (PA) and presence of PHT were judged as normal or mildly, moderately or severely changed.
Results and Conclusions
- The study found that inter-observer agreement was generally low, with only 61% total agreement and a kappa (k) value of 0.21, indicating slight agreement. For experienced observers, the percent agreement was higher at 77%, with a k value of 0.34, while inexperienced observers had a 52% agreement with a k value of 0.18.
- Intra-observer agreement for experienced observers was more consistent, with over 80% agreement (k value of 0.35 to 0.76) but less reliable for beginners (less than 80% agreement and k value of 0.33 to 0.54).
- Abnormalities in the RH size and function were more common in the PHT group, which allowed high specificity, albeit with low sensitivity in detecting PHT.
- In conclusion, the study suggests that subjective RH assessment, although useful, has challenges in terms of reliability and is heavily dependent on the observer’s experience.
- The research also pointed out that the absence of specific RH changes does not conclusively rule out the presence of PHT. When RH changes are detected, it suggests the presence of PHT.
Cite This Article
APA
van Spijk JN, Junge HK, Eberhardt C, Wolf N, Vogt D, Zscherpe P, Herger E, Straub M, Schwarzwald CC.
(2025).
Evaluation of Subjective Assessment of Right Heart Size and Function Using Standard 2D-Echocardiographic Recordings in Horses With and Without Pulmonary Hypertension.
J Vet Intern Med, 39(4), e70145.
https://doi.org/10.1111/jvim.70145 Publication
Researcher Affiliations
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
- Equine Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Munich, Germany.
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
- Equine Department, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland.
MeSH Terms
- Animals
- Horses
- Hypertension, Pulmonary / veterinary
- Hypertension, Pulmonary / diagnostic imaging
- Hypertension, Pulmonary / pathology
- Horse Diseases / diagnostic imaging
- Horse Diseases / physiopathology
- Horse Diseases / pathology
- Echocardiography / veterinary
- Male
- Female
- Observer Variation
- Heart / anatomy & histology
- Heart / diagnostic imaging
- Heart / physiopathology
- Pulmonary Artery / diagnostic imaging
- Sensitivity and Specificity
Conflict of Interest Statement
Authors declare no off‐label use of antimicrobials. The authors declare no conflicts of interest.
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