Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms

Hoffmann, Rainer; Lethen, Harald; Marwick, Thomas H.; Arnese, Mariarosaria; Fioretti, P.; Pingitore, Alessandro; Picaño, Eugenio; Buck, Thomas; Erbel, Raimund; Flachskampf, Frank A.; Hanrath, Peter

doi:10.1016/0735-1097(95)00483-1

Cited by 537 publications

(252 citation statements)

References 19 publications

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“…Those results were confirmed by [6]. The concept of using tissue Doppler for quantitative analysis of myocardial motion is superior to the very poor reproducibility achieved by just using eye-balling of grey scale information [7]. The goal of the present study is to perform intra-and inter-individual reproducibility calculations for all cardiac phases, not only systole but also diastolic measurements, and to evaluate the reproducibility of velocity based derived information like displacement, deformation (strain) and deformation velocity (strain-rate).…”

Section: Introductionsupporting

confidence: 70%

Intra- and interobserver reproducibility in off-line extracted cardiac tissue Doppler velocity measurements and derived variables

Gaballa¹,

Lind²,

Storaa³

et al.

2001 Conference Proceedings of the 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Abstract-Aims: Using post-processing software it is possible to extract tissue velocities from colour-coded Doppler information in numerous positions in the myocardial wall. From velocity other variables such as displacement and deformation (strain) can be calculated. For adequate clinical assessment multiple measurements are needed. This is why reproducibility of the method must be evaluated. Methods: A moderately experienced observer measured systolic and diastolic basal velocity, displacement, strain rate and strain in right and left ventricular walls in 14 patients. The measurements were compared to those acquired by an experienced observer. Results: The inter-observer variability for the systolic longitudinal and radial velocity was 6.9% and 12.0% for the right and 5.8% and 11.9% for the left ventricle respectively. The results with the least reproducibility were obtained for the radial strain rate where the inter-observer variability was 27.9% and 16.2% for the right and left ventricles respectively. Left ventricular velocity measurements had slightly better reproducibility than right ventricular. Derived calculations had a larger variation. Conclusion: Basal velocity measurements and displacement calculations could be performed in the clinical routine by different observers with high reproducibility. Derived variables depending on multiple measuring locations could still be performed but with a method uncertainty of almost 15%.1 Keywords-Reproducibility, Doppler, tissue velocity, strain, strain rate. I. INTRODUCTIONExtraction of velocity profiles from colour coded tissue Doppler images is a modality that has been developed during the last decade [1,2]. Tissue Doppler measurement was first described by Isaaz et al. [3] and could at that time only be performed in one single spot during a heart cycle by using the high amplitude and low pass filtered information in an ordinary pulsed Doppler signal.By using cross correlation technique instead of Fourier spectral analysis myocardial velocities could be extracted as colour information instead of velocity curves. It has always been said that colour velocity only measures mean velocity but by pulsed Doppler real maximal velocities could also be acquired. This is true when velocities in hydraulic fluids like blood are measured but of less importance when velocity of tissue compartments is evaluated as e.g. myocardial wall velocity where all muscle fibres are more or less glued together resulting in small differences between minimum and maximum velocities. The concept of extracting velocity profiles from colour information has the advantage thatThe work is supported by the Swedish Heart Lung Foundation.nearly an infinite number of spatial locations could be evaluated from one single acquired heart beat giving valuable information about spatial differences in velocity profiles without too much biological time dependant variation. Earlier studies of reproducibility in pulsed tissue Doppler recordings have shown that the reproducibility is better for cardiac long axi...

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Section: Introductionsupporting

confidence: 70%

Intra- and interobserver reproducibility in off-line extracted cardiac tissue Doppler velocity measurements and derived variables

Gaballa¹,

Lind²,

Storaa³

et al.

2001 Conference Proceedings of the 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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“…This system allowed substantial sparing of human and technologic resources, but it was also the logical prerequisite for a large‐scale study, designed to represent the realistic performance of the test rather than the results of a single laboratory—or even a single person—working in a highly dedicated echo laboratory. Because the assessment of the echocardiograms was qualitative and subjective, variability in reading the echocardiograms might have modulated the results of individual centers,54 especially for some parameters (eg, LV mass, which can be assessed with accuracy only with quantitative, relatively elaborated assessment). However, all of our readers in individual centers had a long‐lasting experience in echocardiography, passed the quality control in stress echo reading as previously described,55 and had extensive experience on execution and interpretation of CFR through joint reading sessions.…”

Section: Discussionmentioning

confidence: 99%

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Lembo

Sicari

Esposito

et al. 2017

JAHA

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BackgroundThe aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries.Methods and ResultsThe study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high‐dose dipyridamole stress echocardiography with transthoracic‐derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high‐dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant.ConclusionsIn patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.

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“…Furthermore, there are different stress modalities (in particular, low-dose dobutamine stress) for the detection of viable myocardium (46). Despite the high reported accuracy of exercise echocardiography in the diagnosis of CHD, the sensitivity and specificity can be affected by multiple factors (58,59). In most cases, decreased accuracy is caused by suboptimal image quality and decreased detection of the endocardial border.…”

Section: Sementioning

confidence: 99%

“…However, one constant problem is reproducibility (58,77,88). Additional second problem is the "low volume" of SE examinations by a single operator in clinical practice (32).…”

Section: Pitfalls and Limitations Of Diagnosing Ischemia Via Echocardmentioning

confidence: 99%

“…The diagnostic accuracy of SE depends on the type of stress procedure utilized, the digital processing technique and the experience of the investigator (59). The inter-institutional observer variance in the interpretation of SE varies from agreements of 100% to 43% in the lowest image quality stress echocardiograms (58). Presently, we have to decide which technique we should select as the gatekeeper to cardiac catheterization (60).…”

Section: Sementioning

confidence: 99%

See 1 more Smart Citation

Echocardiographic assessment of myocardial ischemia

Leischik¹,

Dworrak²,

Sanchís-Gomar³

et al. 2016

Ann. Transl. Med.

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Over the last 60 years, echocardiography has emerged as a dominant and indispensable technique for the detection and assessment of coronary heart disease (CHD). In this review, we will describe and discuss this powerful tool of cardiology, especially in the hands of an experienced user, with a focus on myocardial ischemia.Technical development is still on-going, and various new ultrasound techniques have been established in the field of echocardiography in the last several years, including tissue Doppler imaging (TDI), contrast echocardiography, three-dimensional echocardiography (3DE), and speckle tracking echocardiography (i.e., strain/strain rateechocardiography). High-end equipment with harmonic imaging, high frame rates and the opportunity to adjust mechanical indices has improved imaging quality. Like all new techniques, these techniques must first be subjected to comprehensive scientific assessment, and appropriate training that accounts for physical and physiological limits should be provided. These limits will constantly be redefined as echocardiographic techniques continue to change, which will present new challenges for the further development of ultrasound technology.

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Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms

Cited by 537 publications

References 19 publications

Intra- and interobserver reproducibility in off-line extracted cardiac tissue Doppler velocity measurements and derived variables

Intra- and interobserver reproducibility in off-line extracted cardiac tissue Doppler velocity measurements and derived variables

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Echocardiographic assessment of myocardial ischemia

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