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Interobserver variability in interpreting contrast left ventriculograms (CASS)
Insights
Quality control centers reread left ventricular cineangiograms from a multicenter study. Results showed good agreement for volume and ejection fraction calculations, and regional wall motion analysis, ensuring reliable data for coronary artery disease research.
Area of Science:
- Cardiology
- Medical Imaging
- Quality Control in Clinical Trials
Background:
- Multicenter studies require rigorous quality control for accurate data.
- Left ventricular cineangiography is crucial for assessing cardiac function in coronary artery disease (CAD).
- Variability in image analysis can impact study outcomes.
Purpose of the Study:
- To evaluate the reliability of left ventricular (LV) volume and ejection fraction (EF) measurements.
- To assess the consistency of regional LV wall motion abnormality analysis.
- To validate data quality from clinical sites against a central quality control (QC) center.
Main Methods:
- Randomly selected LV cineangiograms from the Coronary Artery Surgery Study (CASS) were recalled and reread by a QC center.
- End diastolic volume (EDV), end systolic volume (ESV), and EF were calculated and compared.
- Regional LV wall motion was assessed in RAO and LAO views, with segments graded for abnormality severity.
Main Results:
- High correlation coefficients were observed for EDV (0.71), ESV (0.84), and EF (0.79) between clinical sites and QC.
- Interobserver differences for regional wall motion abnormalities were low (7% RAO, 10% LAO) after excluding minor discrepancies.
- Overall agreement for total LV scores, reflecting wall motion severity, showed a strong correlation (0.83).
Conclusions:
- Centralized quality control of left ventricular cineangiograms ensures reliable measurements of LV volumes, EF, and regional wall motion.
- The established QC procedures provide confidence in the data used for the CASS multicenter study.
- Standardized analysis protocols are effective in minimizing interobserver variability in cardiac imaging assessments.
Abstract:
Randomly selected left ventricular cineangiograms performed by 14 medical centers (clinical sites) participating in a large multicenter study of medical and surgical treatment of coronary artery disease (CASS) were systematically recalled and reread by one of four designated quality control centers. The end diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) calculated by the quality control center were compared with those calculated by the clinical site, and correlation coefficients of 0.71, 0.84, and 0.79, respectively, were obtained. Regional left ventricular (LV) wall motion abnormalities were assessed by dividing the LV wall as viewed in the right anterior oblique (RAO) and left anterior oblique (LAO) views into five segments each and grading the motion of each segment according to six categories of increasing abnormalities from normal to aneurysm. When discrepancies based on "nearest neighbor" differences in naming adjacent segments were eliminated and only marked differences of more than one degree of severity of wall motion abnormality were considered, interobserver differences were 7% and 10% for RAO and LAO segments, respectively. Agreement was less frequent in designating a segment "aneurysmal." When each LV segment was assigned a numerical score based on increasing severity of wall motion abnormality and a total LV score for each ventriculogram computed, the quality control and clinical site readings were in good agreement with a correlation coefficient of 0.83.