Variability in the analysis of coronary arteriograms.

Abstract

provide views at 900 angles to one another. No hemiaxial views were taken. A stratified random sampling scheme was used to ensure selection of a representative spectrum of coronary disease groups, as categorized by the number of major vessels with at least 70% stenosis and by normal or abnormal left ventricular function. Only films estimated to be of adequate technical quality were eligible for this study. Eleven physicians, representing the Seattle Heart Watch cooperating facilities, individually reviewed these ten films in a pre-assigned random order and completed the standard Heart Watch arteriography forms. Three of the eleven subsequently met to resolve differences of opinion and provide a joint reading which could serve as a standard from an "expert panel."Raw observations collected were: the estimated amount of stenosis (percent narrowing in the diameters) of each of ten vessel segments, the presence or absence of collaterals, the degree of left ventricular contraction according to a qualitative five-division grading, as well as a film quality rating, and an overall assessment of the presence of coronary artery disease.The statistical approach taken for all entirely numerical variables was to use the standard deviation of the responses as a measure of the amount of variability and thus of the amount of agreement. When considering the amount of agreement on variables that were at least partially nominal in nature, standard deviations were not always applicable. For example, each reader was asked to estimate the amount of narrowing (to the nearest 10%) in the diameters of each of ten vessel segments from each patient. However, when the vessel segment was not sufficiently visible to allow an assess-324 CIRCULATION by guest on

Plasma apoproteins and the severity of coronary artery disease.

“…The coefficient of variation in coronary score of 12% for the single observer was lower than coefficients of variation reported by others for interobserver variability when more than one observer performed the analyses. 19,20 Each of the following 17 variables was correlated with the coronary artery score: total triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol,2' apoAI,22 apoAII,23 apoB,24 apoE,25 apoE levels in VLDL (VLDL-apoE), the ratio of apoE in VLDL to total apoE levels (VLDL-apoE/total apoE), the ratios of apoAl/apoAll, HDL/LDL, apoAl/apoB, and age, smoking, and histories of diabetes and hypertension. …”

Novel Insights Into Stenosis on Coronary Angiography–Outline of Functional Assessment of Stable Angina Patients with Angiographic Stenosis

“…There is 20% variation among readings of experienced angiographers, and the same angiographer may even render a different interpretation at a time remote from the first reading. Borderline stenosis, or angiographic narrowing of 40 to 70%, does not always correspond to abnormal physiology and myocardial ischemia (1,2). For such lesions, noninvasive or direct physiological measurements of impaired flow validate the decision to initiate revascularization therapy.…”

Videodensitometric analysis of human coronary stenoses: validation in vivo by intraoperative high-frequency epicardial echocardiography.

“…[1][2][3][4] In addition, measurements of percent stenosis in patients with multivessel coronary artery disease may not correlate with coronary lesion geometry, as defined by the method of quantitative coronary arteriography described by Brown et al. ', or lesion physiologic significance, as defined by intraoperative Doppler reactive hyperemia studies.…”