Right ventricular volume inter-reader variability increases with ventricular dilation: results from the pvdomics study

SESSION TITLE: Pulmonary Vascular Disease Posters 10 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: There is limited data on inter-reader variability in cardiac MRI (CMR) reading of ventricular volumes across the spectrum of pulmonary vascular disease. The aim of this analysis is to assess variability between the CMR core lab and clinical centers enrolling subjects in the PVDOMICS study. METHODS: CMR data was obtained from 7 clinical centers and analyzed at the core lab in the Pulmonary Vascular Disease Phenomics Program (PVDOMICS), a prospective cohort study of N= 727 with MRI aimed to assess phenotypic differences among the WSPH group PH categories, WSPH comparator groups (mean pulmonary artery pressure <25mmHg), and healthy controls. Each CMR was read by different readers at the core laboratory and the clinical site. The short-axis stack was used to measure right ventricular (RV) end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF), as well as left ventricular (LV) EDV, ESV, and EF. Manual contouring was done without automation. Inter-reader analysis of individual centers compared with the core laboratory was performed using Bland-Altman (BA) analysis and correlations. BA analyses are represented as bias[limits of agreement] (LOA). Bias is represented as the core center to clinical site difference. RESULTS: A subset of 583/727 (80%) subjects with both core and clinical site data were included in the statistical analysis. Of the 7 centers, 1 center had significant bias in both RV and LV volumes (i.e., RVEDV 64[-18-146]mL and LVEDV 29[1-57]mL) due to systematic differences in basal RV contouring. Therefore, the remaining 6 centers were combined for volume analysis. There was good correlation between all volumes between readers (i.e., RVEDV R=0.94 and LVEDV R=0.94) and minimal bias (i.e., RVEDV -1.6[-49-46]mL, RVESV 0.58[-37-38]mL, RVEF -0.8[-14-13], LVEDV 7.26[-22-36]mL, LVESV 8.29[-16-33]mL, LVEF -1.41[-20-17]). When examining inter-reader variability above and below the median ventricular volume or EF, bias remained minimal, but LOA increased for the RV but not the LV (i.e., RVEDV -0.0[-35-35]mL and -3.1[-60-54]mL for RV ≤ and > 158mL, respectively versus LVEDV 7[-18-31]mL and 8[-25-41]mL for LV ≤ and > 124mL, respectively). Variability in EF was not seen (i.e., RVEF -1.1[-15-13] and -0.5[-14-13] for EF ≤ and > 48%, respectively). CONCLUSIONS: Inter-reader variability for RV and LV volumes and EF are consistent with previously published results across the spectrum of pulmonary vascular disease in PVDOMICS. Although volume precision estimates decrease as the RV dilates (LOA increases), EF appears unaffected. CLINICAL IMPLICATIONS: The clinical implications of RV and LV LOA should be considered when evaluating prognostic cutoffs using CMR. Future research should focus on a protocolized measurement approach to improve inter-reader consistency. 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