A quality control exercise in the echo laboratory: Reduction in inter‐observer variability in the interpretation of pulmonary hypertension

Background Right ventricular systolic pressure ( RVSP ) estimated by echocardiography is critical for the initial screening and follow‐up of pulmonary hypertension ( PH ). Inter‐observer variability ( IOV ) in RVSP can impact clinical decision making. This study assessed whether a simple guideline‐based teaching intervention could reduce the IOV in RVSP interpretation. Methods and Results Eleven participants in a high‐volume tertiary level echocardiography laboratory underwent an assessment of the baseline IOV in the assessment of RVSP for a series of transthoracic echocardiograms ( TTE ), depicting various degrees of PH among 8 cases each before and after a teaching intervention. The inter‐observer variance (root‐mean‐square error) decreased from 26.0 mm Hg 2 (5.1 mm Hg) at baseline to 5.8 mm Hg 2 (2.4 mm Hg) post‐teaching intervention ( P  = .025). The corresponding inter‐class coefficient ( ICC ) increased from 0.89 to 0.98. Several factors relating to image acquisition and interpretation were identified as contributing to IOV in RVSP . The outcome was the development of a practical tool to mitigate these factors. Conclusions A simple structured teaching intervention successfully reduced IOV in the measurement of RVSP in a high‐volume echo laboratory.