Interobserver and intraobserver variability among different vendors for mitral valve assessment: implications for transcatheter mitral valve repair

Purpose: Pre-procedural imaging is critical for transcatheter mitral valve repair planning in patients with mitral valve disease. As differences among various measurement techniques for valve evaluation are still poorly understood, we sought to assess the intra- and interobserver agreement of complex measurements derived from a prototype mitral evaluation tool (Siemens) and a commercially available tool (CVI42) using both saddle- and D-shaped mitral annulus techniques. Materials and methods: Multiphasic cardiac computed tomography angiography data were loaded into each software. Three expert readers independently measured the annuli on systolic- and diastolic-phase images using both tools. Measurement agreement between the tools was assessed with t tests, with p ≤ 0.05 considered statistically significant. Intraclass correlation coefficient (ICC) was used for interobserver agreement. Bland–Altman plots were used to assess for systematic differences. Results: Ten patients (mean age: 61.9 ± 9.9 years, 70%males) were included, with either normal mitral valve (n = 5) or with primary mitral regurgitation (n = 5). The intraobserver comparison showed statistically significantly different circumference and planar surface areas only for one reader in each group. However, there was significant difference (p ≤ 0.05) between measurements for intercommissural distance, septolateral distance, and intertrigone distance. The interobserver agreement was good (ICC, 0.60–0.74) to excellent (ICC, 0.75–1.00). There were systematic differences in mitral annulus area parameters for both saddle- and D-shaped annulus. Conclusion: Both tools effectively assess mitral annulus with good-to-excellent interobserver agreement. As there were systematic differences in the annular area and distance, use of the same software should be considered in clinical and research workflows.