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7%) cases and κ 0.88 [0.75, 1.01]. Agreement for PhyS was less robust, with consensus on 24/41 cases (59.5%), κ 0.57 [0.39, 0.75]. Expert-RA agreement was lower for AnatC (κ 0.77 [0.60, 0.95]), whereas PhyS was similar to interexpert agreement (κ 0.53 [0.34, 0.72]). There was ambiguity in the definitions of (1) arrhythmia status, (2) cyanotic CHD, and (3) valve disease. Although AnatC can be assessed reliably, that is not true for the PhyS part of the AP classification proposed in the 2018 American College of Cardiology/American Heart As