Inter-observer differences in interpretation of coronary pressure-wire pullback data by non-expert interventional cardiologists
Inter-observer differences in interpretation of coronary pressure-wire pullback data by non-expert interventional cardiologists
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非专业介入心脏病专家对冠状动脉压力线拉回数据解释的观察者间差异
DOI：
10.1007/s12928-020-00673-3
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Takayuki Warisawa;James P Howard;Christopher M Cook;Yousif Ahmad;Shunichi Doi;Masafumi Nakayama;Sonoka Goto;Yohei Yakuta;Kenichi Karube;Fumiyasu Seike;et al.
通过压力导丝（PW）回撤确定的冠状动脉疾病的生理模式对于血运重建和患者风险分层的决策非常重要。然而，目前尚不清楚解释PW回撤数据的观察者间差异是否取决于医生的专业知识。本研究旨在探讨非专家评估的主观性。介入心脏病专家将545个PW回撤迹线分类为生理性局灶性或生理性弥漫性疾病模式。以专家共识为参考标准，对10名非专家医生的分类绩效进行评价。观察者通过两种方式进行分层：（i）作为介入心脏病专家的经验（中级与初级）和（ii）他们所属机构的数量（高容量中心与低容量中心）。当根据专家共识判断时，非专家观察者在评估疾病生理模式（局灶性或弥漫性）方面的一致性范围为69.1%至85.0%（异质性p < 0.0001）。没有证据表明经验年限的调节作用;中级医生的合并准确率为78.8%（95%置信区间[CI] 72.8-84.7%），初级医生为79.1%（95% CI 75.9- 82.2%，p = 0.95）。另一方面，我们观察到一个显着的调节作用的中心体积。高容量中心非专家的准确性为82.7%（95%CI 80.3-85.1%），低容量中心为75.1%（95%CI 71.9- 78.3%，p = 0.0002）。非专业介入心脏病专家对PW回撤的解释相当主观。
The physiological pattern of coronary artery disease as determined by pressure-wire (PW)-pullback is important for decision-making of revascularization and risk stratification of patients. However, it remains unclear whether inter-observer differences in interpreting PW-pullback data are subject to the expertise of physicians. This study sought to investigate the subjectivity of this assessment among non-experts. Expert interventional cardiologists classified 545 PW-pullback traces into physiologically focal or physiologically diffuse disease pattern. Defining expert-consensus as the reference standard, we evaluated ten non-expert doctors’ classification performance. Observers were stratified equally by two ways: (i) years of experience as interventional cardiologists (middle-level vs. junior-level) and (ii) volume of institutions where they belonged to (high-volume center vs. low-volume center). When judged against the expert-consensus, the agreement of non-expert observers in assessing physiological pattern of disease (focal or diffuse) ranged from 69.1 to 85.0% (pfor heterogeneity < 0.0001). There was no evidence for a moderating effect of years of experience; the pooled accuracy of middle-level doctors was 78.8% (95% confidential interval [CI] 72.8–84.7%) vs. 79.1% for junior-level doctors (95% CI 75.9–82.2%,p= 0.95 for difference). On the other hand, we observed a significant moderating effect of center volume. Accuracy across non-experts in high-volume centers was 82.7% (95% CI 80.3–85.1%) vs. 75.1% for low-volume centers (95% CI 71.9–78.3%,p= 0.0002 for difference). Interpretation of PW-pullback by non-expert interventional cardiologists was considerably subjective.
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影响因子：
3.2
作者：
Kawase, Yoshiaki;Omori, Hiroyuki;Matsuo, Hitoshi
通讯作者：
Matsuo, Hitoshi
影响因子：
3.3
作者：
Lee, Joo Myung;Rhee, Tae-Min;Koo, Bon-Kwon
通讯作者：
Koo, Bon-Kwon
影响因子：
11.3
作者：
Chandrasekhar, Jaya;Baber, Usman;Mehran, Roxana
通讯作者：
Mehran, Roxana
DOI：
10.1161/circinterventions.118.007494
发表时间：
2019-05-01
影响因子：
5.6
作者：
Warisawa, Takayuki;Cook, Christopher M.;Davies, Justin E.
通讯作者：
Davies, Justin E.
影响因子：
11.3
作者：
Kikuta, Yuetsu;Cook, Christopher M.;Davies, Justin E.
通讯作者：
Davies, Justin E.