Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms
R Hoffmann,
H Lethen,
T Marwick,
M Arnese,
P Fioretti,
A Pingitore,
E Picano,
T Buck,
R Erbel,
FA Flachskampf,
and
P Hanrath
Medical Clinic I, Rheinisch Wesfalische Techische Hochschule Aachen, Germany.
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 micrograms/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 (> or = 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 interinstitutional 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.
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D J A Price, D R Wallbridge, and M J Stewart
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R Rambaldi, D Poldermans, J.J Bax, E Boersma, A Elhendy, W Vletter, J.R.T.C Roelandt, and R Valkema
Doppler tissue velocity sampling improves diagnostic accuracy during dobutamine stress echocardiography for the assessment of viable myocardium in patients with severe left ventricular dysfunction
Eur. Heart J.,
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[Abstract]
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A Franke, R Hoffmann, H P Kühl, W Lepper, O A Breithardt, M Schormann, and P Hanrath
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Heart,
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[Abstract]
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G. M. Pohost and R. W. W. Biederman
The Role of Cardiac MRI Stress Testing : "Make a Better Mouse Trap ... "
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October 19, 1999;
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W. G. Hundley, C. A. Hamilton, M. S. Thomas, D. M. Herrington, T. B. Salido, D. W. Kitzman, W. C. Little, and K. M. Link
Utility of Fast Cine Magnetic Resonance Imaging and Display for the Detection of Myocardial Ischemia in Patients Not Well Suited for Second Harmonic Stress Echocardiography
Circulation,
October 19, 1999;
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[Abstract]
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R. Hoffmann, H. Lethen, H. Kuhl, W. Lepper, and P. Hanrath
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Eur. Heart J.,
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[Abstract]
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W. A. Zoghbi and E. Barasch
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D. Poldermans, P. M. Fioretti, E. Boersma, J. J. Bax, I. R. Thomson, J. R. T. C. Roelandt, and M. L. Simoons
Long-Term Prognostic Value of Dobutamine-Atropine Stress Echocardiography in 1737 Patients With Known or Suspected Coronary Artery Disease : A Single-Center Experience
Circulation,
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99(6):
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[Abstract]
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E. Nagel, H. B. Lehmkuhl, W. Bocksch, C. Klein, U. Vogel, E. Frantz, A. Ellmer, S. Dreysse, and E. Fleck
Noninvasive Diagnosis of Ischemia-Induced Wall Motion Abnormalities With the Use of High-Dose Dobutamine Stress MRI : Comparison With Dobutamine Stress Echocardiography
Circulation,
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[Abstract]
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P. C. Yang, A. B. Kerr, A. C. Liu, D. H. Liang, C. Hardy, C. H. Meyer, A. Macovski, J. M. Pauly, and B. S. Hu
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December 1, 1998;
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[Abstract]
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M. S. Lauer, R. Mehta, F. J. Pashkow, P. M. Okin, K. Lee, and T. H. Marwick
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I. Afridi, P. A. Grayburn, J. A. Panza, J. K. Oh, W. A. Zoghbi, and T. H. Marwick
Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction
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R. L. Larsen, P. M. Applegate, D. A. Dyar, P. A. Ribeiro, S. D. Fritzsche, N. F. Mulla, G. S. Shirali, M. A. Kuhn, R. E. Chinnock, and P. M. Shah
Dobutamine stress echocardiography for assessing coronary artery disease after transplantation in children
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[Abstract]
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G. Geskin, C. M. Kramer, W. J. Rogers, T. M. Theobald, D. Pakstis, Y.-L. Hu, and N. Reichek
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Circulation,
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[Abstract]
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L. Cortigiani, E. Picano, P. Landi, M. Previtali, S. Pirelli, P. Bellotti, R. Bigi, O. Magaia, A. Galati, E. Nannini, et al.
Value of pharmacologic stress echocardiography in risk stratification of patients with single-vessel disease: a report from the echo-persantine and echo-dobutamine international cooperative studies
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[Abstract]
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S.-C. Chuah, P. A. Pellikka, V. L. Roger, R. B. McCully, and J. B. Seward
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[Abstract]
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E. Lazzeroni, E. Picano, L. Morozzi, A. R. Maurizio, G. Palma, R. Ceriati, E. Iori, and A. Barilli
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D. A. Calnon, D. K. Glover, G. A. Beller, G. Vanzetto, W. H. Smith, D. D. Watson, and M. Ruiz
Effects of Dobutamine Stress on Myocardial Blood Flow, 99mTc Sestamibi Uptake, and Systolic Wall Thickening in the Presence of Coronary Artery Stenoses : Implications for Dobutamine Stress Testing
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October 7, 1997;
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[Abstract]
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V. L. Roger, P. A. Pellikka, M. R. Bell, C. W.H. Chow, K. R. Bailey, and J. B Seward
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R. O. Bonow
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