# Interobserver Reproducibility of the Visual Echocardiographic Scoring System for Left Ventricular Filling Pressure

## TL;DR

This study shows that a simple echocardiographic method for assessing heart pressure is highly reliable across different users and devices.

## Contribution

Demonstrates excellent interobserver agreement for a handheld echocardiographic scoring system across varying expertise and equipment.

## Key findings

- 11 out of 27 patients had VMT scores ≥2, indicating elevated left ventricular filling pressure.
- Interobserver agreement for VMT scoring had a weighted kappa of 0.97, indicating almost-perfect concordance.
- Agreement was consistent regardless of operator experience or device type (handheld vs. stationary).

## Abstract

Background

The visually assessed time difference between mitral and tricuspid valve opening (VMT) scoring is a simple B-mode echocardiographic method for estimating left ventricular filling pressure (LVFP). This study aimed to evaluate the interobserver reproducibility of VMT scoring between a resident doctor using a handheld ultrasound device and experienced sonographers using a stationary system.

Methodology

In this prospective observational study, 27 inpatients underwent two echocardiographic examinations on the same day: a handheld ultrasound performed by a resident doctor and standard echocardiography performed by cardiac sonographers. Both observers independently assessed VMT scores (0-3) based on the time sequence of atrioventricular valve opening and inferior vena cava findings. Interobserver agreement was evaluated using weighted kappa statistics.

Results

Among the 27 patients (mean age = 76 ± 12 years; 56% female), 11 (41%) had a VMT score ≥2, indicating elevated LVFP. The weighted kappa value for interobserver agreement was 0.97, demonstrating almost-perfect concordance regardless of operator experience or device type.

Conclusions

VMT scoring appears to be a practical and reliable method for LVFP evaluation in diverse clinical settings, particularly those with limited access to expert echocardiography.