[Agreement between observers with different experience in the interpretation of the stress myocardial perfusion
T Massardo1, H Lavados, R Jaimovich
1Sección de Medicina Nuclear, Departamento de Medicina y Sección Ergometría, Centro Cardiovascular del Hospital Clínico de la Universidad de Chile, Santiago, Chile. tmassardo@redclinicauchile.cl
Insights
Stress electrocardiogram (ECG) interpretation for coronary artery disease (CAD) shows good reproducibility, especially with experienced cardiologists. Training significantly impacts the accuracy of stress ECG analysis in detecting myocardial ischemia.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Procedures
Background:
- Coronary artery disease (CAD) is a leading global cause of mortality.
- Stress electrocardiogram (ECG) aids in detecting myocardial ischemia and offers prognostic value, but baseline electrical abnormalities can impair its accuracy.
- Stress myocardial single-photon emission computed tomography (SPECT) is valuable for CAD assessment, necessitating independent interpretation of ECG and myocardial images.
Purpose of the Study:
- To evaluate the reproducibility of stress ECG interpretation across different levels of medical training.
- To compare stress ECG interpretation by trainees and an experienced cardiologist against SPECT findings.
- To assess the impact of observer experience on the accuracy of stress ECG analysis for CAD.
Main Methods:
- Ninety-five patients undergoing CAD evaluation were studied.
- Interobserver correlation (kappa statistic) was calculated for stress ECG and (99m)Tc-Sestamibi SPECT findings (normal/abnormal, necrosis, ischemia, mixed pattern).
- Comparisons were made between initial reports, an independent cardiologist, and SPECT results.
Main Results:
- Initial reports showed 49.5% abnormal stress ECGs and 45% abnormal SPECTs, with moderate agreement (kappa 0.24 for normal/abnormal, 0.14 for ischemia).
- Agreement between initial stress ECG reports and an independent cardiologist was high (89.5%, kappa 0.78).
- Interobserver agreement for ischemia detection on stress ECGs ranged from 80% to 93.7% (kappa 0.59-0.87).
Conclusions:
- Stress ECG interpretation demonstrates adequate interobserver reproducibility.
- Greater agreement in interpretation is observed among more experienced physicians, highlighting the critical role of training.
- Stress ECG remains a valuable tool for CAD evaluation when interpreted by trained professionals.
Unlabelled:
Coronary artery disease (CAD) is the leading cause of death in many countries. Stress electrocardiogram (ECG) is able to detect myocardial ischemia and also has prognostic value, which may be impaired in presence of electrical baseline abnormalities. Stress myocardial single photon emission tomography (SPECT) has recognized utility yield in assessment of CAD, requiring independent interpretation of ECG and myocardial images.
Purpose:
To analyze stress ECG interpretation reproducibility among observers with different training level, including pre- and post-graduate medical students, compared to an experienced cardiologist and also with SPECT.
Method:
We studied 95 patients under CAD evaluation, mean age 61+/-9.3 years (range: 42-85), 56% male. Interobserver correlation kappa (k) between perfusion gated (99m)Tc-Sestamibi SPECT and exercise ECG were calculated as normal/abnormal, presence of necrosis, ischemia or mixed pattern. Interobserver kappa (k) analysis was made.
Results:
49.5% stress ECG and 45% SPECT studies were abnormal at the initial report with 62.1% concordance (k: 0.24) for normal/abnormal and 58.9% for ischemia (k: 0.14). Agreement between stress ECG initial report and independent cardiologist was 89.5% (k: 0.78). The correlation between independent observers and the initial report ranged between 62.1% and 48.4%, for baseline ECG between 41.1% and 90.5% considering normal/abnormal, and between 80% and 93.7% (k: 0.59-0.87) for the presence of ischemia.
Conclusion:
Stress ECG interpretation presented adequate interobserver reproducibility with greater agreement in the most experienced observers, confirming the importance of training.
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