Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms
Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms
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DOI：
10.1016/0735-1097(95)00483-1
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发表时间：
1996-02-01
影响因子：
24
通讯作者：
Hanrath, P
中科院分区：
文献类型：
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作者：
Hoffmann, R;Lethen, H;Hanrath, P
目标.本研究旨在确定机构间对多巴酚丁胺负荷超声心动图的一致性程度。多巴酚丁胺负荷超声心动图涉及主观解释。一致的采集和解释方法对于获得高度的观察者间一致性和促进测试结果的交流至关重要。要求五个有经验的中心各提交30张多巴酚丁胺负荷超声心动图（多巴酚丁胺高达40 μ g/kg体重/min，阿托品高达1 mg），这些都是在接受冠状动脉造影术的患者中获得的。因此，在不了解任何其他患者数据的情况下，每个中心共解读了150份多巴酚丁胺负荷超声心动图。左室壁运动采用16节段模型进行评估，但在其他方面没有标准化。没有患者因为图像质量差或应力水平不足而被排除。超声心动图图像质量采用5分制进行评价。95例患者（63%）存在血管造影显著冠状动脉疾病（直径狭窄≥ 50%）。以多数决定多巴酚丁胺负荷超声心动图的敏感性、特异性和准确性分别为76%、87%和80%。73%的患者负荷超声心动图异常或正常结果得到4个或所有5个中心的一致同意（平均kappa值0.37，仅一般一致性），左前降支动脉区域的一致性（78%）与右冠状动脉/左回旋支联合区域的一致性（74%）相似，对于特定节段，一致性范围为84%至97%，基底前段最高，基底下段最低，无冠状动脉疾病（82%）或三支血管冠状动脉疾病（100%）的患者的一致性较高，而患有一支或两支血管疾病的患者的一致性较低（分别为61%和68%）。对于图像质量最高的患者，负荷试验结果阳性或阴性的一致性为100%，但对于图像质量最低的患者，仅为43%（p = 0.003）。目前不同中心之间的数据采集和评估标准的异质性导致负荷超声心动图解释的机构间一致性较低。无冠状动脉疾病或晚期冠状动脉疾病患者的一致性较高，而超声心动图图像质量有限的患者的一致性明显较低。为了提高机构间的一致性，建议更好地标准化负荷超声心动图的图像采集和阅读标准。
Objectives. This study sought to determine the degree of interinstitutional agreement in the interpretation of dobutamine stress echocardiograms.Background. Dobutamine stress echocardiography involves subjective interpretation. Consistent methods for acquisition and interpretation are of critical importance for obtaining high interobserver agreement and for facilitating communication of test results.Methods. Five experienced centers were each asked to submit 30 dobutamine stress echocardiograms (dobutamine up to 40 mu g/kg body weight per min and atropine up to 1 mg) obtained in patients undergoing coronary angiography. Thus, a total of 150 dobutamine stress echocardiograms were interpreted by each center without knowledge of any other patient data. Left ventricular wall motion was assessed using a 16-segment model but was otherwise not standardized. No patient was excluded because of poor image quality or inadequate stress level. Echocardiographic image quality was assessed using a five point scale.Results. Angiographically significant coronary artery disease (greater than or equal to 50% diameter stenosis) was present in 95 patients (63%). By a majority decision (three or more centers), the sensitivity, specificity and accuracy of dobutamine echocardiography were 76%, 87% and 80%, respectively, Abnormal or normal results of stress echocardiography were agreed on by four or all five of the centers in 73% of patients (mean kappa value 0.37, fair agreement only), Agreement on the left anterior descending artery territory (78%) was similar to that for the combined right coronary artery/left circumflex artery territory (74%), and for specific segments the agreement ranged from 84% to 97% and was highest for the basal anterior segment and lowest for the basal inferior segment, Agreement was higher in patients with no (82%) or three-vessel coronary artery disease (100%) and lower in patients with one- or two vessel disease (61% and 68%, respectively). Agreement on positivity or negativity of stress test results was 100% for patients with the highest image quality but only 43% for those with the lowest image quality (p = 0.003).Conclusions. The current heterogeneity in data acquisition and assessment criteria among different centers results in low inter institutional agreement in interpretation of stress echocardiograms. Agreement is higher in patients with no or advanced coronary artery disease and substantially lower in those with limited echocardiographic image quality. To increase interinstitutional agreement, better standardization of image acquisition and reading criteria of stress echocardiography is recommended.