Agreement is poor among current criteria used to define response to cardiac resynchronization therapy.
Agreement is poor among current criteria used to define response to cardiac resynchronization therapy.
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DOI：
10.1161/circulationaha.109.910778
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发表时间：
2010-05-11
期刊：
影响因子：
37.8
通讯作者：
Oshinski JN
中科院分区：
文献类型：
--
作者：
Fornwalt BK;Sprague WW;BeDell P;Suever JD;Gerritse B;Merlino JD;Fyfe DA;León AR;Oshinski JN
文献中使用了许多被认为定义心脏再同步治疗（CRT）积极反应的标准。没有研究调查这些反应标准之间的一致性。我们假设各种响应标准之间的一致性会很差。使用关键词“心脏再同步”和“反应”进行文献检索。审查了被引用次数最多的 50 篇出版物。排除社论和评论后，从 26 篇相关文章中确定了 17 种不同的主要反应标准。使用 Cohen κ 系数在来自 PROSPECT 研究的 426 名患者中评估了这 17 个响应标准中的 15 个之间的一致性（两个响应标准无法从 PROSPECT 数据计算）。对于 15 项答复标准，总体答复率为 32-91%。 99% 的患者根据 15 条标准中的至少一项显示出阳性反应，而 94% 的患者根据至少一项标准被归类为无反应者。计算 15 个响应标准中所有 105 种可能的比较的 Kappa 值，并将其分为标准范围：一致性较差 (κ≤0.4)、中等一致性 (0.4<κ<0.75) 和高度一致性 (κ≥0.75)。 75% 的比较显示较差的一致性，21% 的比较显示中等的一致性，只有 4% 的比较显示强烈的一致性。 26 篇引用最多的关于预测 CRT 反应的出版物使用 17 种不同的标准定义反应。定义 CRT 反应的不同方法之间的一致性在 75% 的情况下很差，只有 4% 的情况下很一致，这严重限制了概括多项研究结果的能力。
Numerous criteria believed to define a positive response to cardiac resynchronization therapy (CRT) have been utilized in the literature. No study has investigated agreement amongst these response criteria. We hypothesized that the agreement between the various response criteria would be poor. A literature search was conducted with the keywords “cardiac resynchronization” and “response”. The 50 publications with the most citations were reviewed. After excluding editorials and reviews, seventeen different primary response criteria were identified from 26 relevant articles. The agreement amongst fifteen of these seventeen response criteria was assessed in 426 patients from the PROSPECT study using Cohen's κ coefficient (two response criteria were not calculable from PROSPECT data). The overall response rate ranged from 32-91% for the fifteen response criteria. Ninety-nine percent of patients showed a positive response by at least one of the fifteen criteria while 94% were classified as a non-responder by at least one criterion. Kappa values were calculated for all 105 possible comparisons amongst the fifteen response criteria and classified into standard ranges: poor agreement (κ≤0.4), moderate agreement (0.4<κ<0.75) and strong agreement (κ≥0.75). Seventy-five percent of the comparisons showed poor agreement, 21% showed moderate agreement and only 4% showed strong agreement. The 26 most cited publications on predicting response to CRT define response using 17 different criteria. Agreement between different methods to define response to CRT is poor 75% of the time and strong only 4% of the time, which severely limits the ability to generalize results over multiple studies.