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Author Notes:

Correspondence: MHPICARD@mgh.harvard.edu

All authors read and approved the final manuscript.

We thank Ms. Dana Oliver in ISCHEMIA Imaging Coordinating Center.

Subjects:

Research Funding:

This work was supported by grants from the Japanese Society of Echocardiography Overseas Research Fellowship and Uehara Memorial Foundation Research Fellowship (Dr. Kataoka), and the National Heart, Lung, and Blood Institute (5U01HL105561-02, 1U01HL10556-01).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • Stress echocardiography
  • ISCHEMIA Trial
  • Interpretation variability
  • Left ventricular myocardial ischemia
  • Image quality
  • OPTIMAL MEDICAL THERAPY
  • MYOCARDIAL-INFARCTION
  • ADMISSION ELECTROCARDIOGRAM
  • EXERCISE ECHOCARDIOGRAPHY
  • LABORATORY INTERPRETATION
  • OBSERVER AGREEMENT
  • DISEASE
  • ASSOCIATION
  • TOMOGRAPHY
  • COURAGE

The value of core lab stress echocardiography interpretations: observations from the ISCHEMIA Trial

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Journal Title:

Cardiovascular Ultrasound

Volume:

Volume 13, Number 1

Publisher:

, Pages 47-47

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Stress echocardiography (SE) is dependent on subjective interpretations. As a prelude to the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) Trial, potential sites were required to submit two SE, one with moderate or severe left ventricular (LV) myocardial ischemia and one with mild ischemia. We evaluated the concordance of site and core lab interpretations. Methods: Eighty-one SE were submitted from 41 international sites. Ischemia was classified by the number of new or worsening segmental LV wall motion abnormalities (WMA): none, mild (1 or 2) or moderate or severe (3 or more) by the sites and the core lab. Results: Core lab classified 6 SE as no ischemia, 35 mild and 40 moderate or greater. There was agreement between the site and core in 66 of 81 total cases (81 %, weighted kappa coefficient [K] =0.635). Agreement was similar for SE type - 24 of 30 exercise (80 %, K = 0.571) vs. 41 of 49 pharmacologic (84 %, K = 0.685). The agreement between poor or fair image quality (27 of 36 cases, 75 %, K = 0.492) was not as good as for the good or excellent image quality cases (39 of 45 cases, 87 %, K = 0.755). Differences in concordance were noted for degree of ischemia with the majority of discordant interpretations (87 %) occurring in patients with no or mild LV myocardial ischemia. Conclusions: While site SE interpretations are largely concordant with core lab interpretations, this appears dependent on image quality and the extent of WMA. Thus core lab interpretations remain important in clinical trials where consistency of interpretation across a range of cases is critical.

Copyright information:

© Kataoka et al. 2015

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

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