Minter Stephanie, Armour Alicia, Tinnemore Amanda, Strub Karen, Crowley Anna Lisa, Bloomfield Gerald S, Alexander John H, Douglas Pamela S, Kisslo Joseph A, Velazquez Eric J, Samad Zainab
Cardiac Diagnostic Unit, Duke University Medical Center, Durham, NC, USA.
Division of Cardiology, Department of Medicine, Duke University Medical Center, 40 Duke Medicine Circle, Duke South, Orange Zone, Rm. 3347 A, Durham, NC, 27710, USA.
Int J Cardiovasc Imaging. 2018 Nov;34(11):1725-1730. doi: 10.1007/s10554-018-1389-y. Epub 2018 Aug 20.
Quality in stress echocardiography interpretation is often gauged against coronary angiography (CA) data but anatomic obstructive coronary disease on CA is an imperfect gold standard for a stress induced wall motion abnormality. We examined the utility of crowd-sourcing a "majority-vote" consensus as an alternative 'gold standard' against which to evaluate the accuracy of an individual echocardiographer's interpretation of stress echocardiography studies. Participants independently interpreted baseline and post-exercise stress echocardiographic images of cases that had undergone follow up CA within 3 months of the stress echo in two surveys, 2 years apart. We examined the agreement of consensus on survey (survey participant response (> 60%) for one decision) with the stress echocardiography clinical read and with CA results. In the first survey, 29 participants reviewed and independently interpreted 14 stress echo cases. Consensus was reached in all 14 cases. There was good agreement between clinical and consensus (kappa = 0.57), survey participant response and consensus (kappa = 0.68) and consensus and CA results (kappa = 0.40). In the validation survey, the agreement between clinical reads and consensus (kappa = 0.75) and survey participant response and consensus (kappa = 0.81) remained excellent. Independent consensus is achievable and offers a fair comparison for stress echocardiographic interpretation. Future validation work, in other laboratories, and against hard outcomes, is necessary to test the feasibility and effectiveness of this approach.
负荷超声心动图解读的质量通常以冠状动脉造影（CA）数据为衡量标准，但CA上的解剖性阻塞性冠状动脉疾病对于负荷诱发的室壁运动异常而言并非完美的金标准。我们研究了众包“多数投票”共识作为一种替代“金标准”的效用，以此来评估个体超声心动图医生对负荷超声心动图研究解读的准确性。参与者在两项相隔2年的调查中，独立解读了在负荷超声心动图检查后3个月内接受了随访CA的病例的基线和运动后负荷超声心动图图像。我们检查了调查中的共识（一项决定的调查参与者回应（>60%））与负荷超声心动图临床解读以及CA结果之间的一致性。在第一次调查中，29名参与者回顾并独立解读了14例负荷超声心动图病例。所有14例病例均达成了共识。临床解读与共识之间（kappa = 0.57）、调查参与者回应与共识之间（kappa = 0.68）以及共识与CA结果之间（kappa = 0.40）存在良好的一致性。在验证性调查中，临床解读与共识之间（kappa = 0.75）以及调查参与者回应与共识之间（kappa = 0.81）的一致性仍然非常好。独立的共识是可以实现的，并且为负荷超声心动图解读提供了公平的比较。未来需要在其他实验室针对硬终点进行验证工作，以测试这种方法的可行性和有效性。
