Echocardiographic agreement in the diagnostic evaluation for infective endocarditis
- 251 Downloads
Echocardiography is essential for the diagnosis and management of infective endocarditis (IE). However, the reproducibility for the echocardiographic assessment of variables relevant to IE is unknown. Objectives of this study were: (1) To define the reproducibility for IE echocardiographic variables and (2) to describe a methodology for assessing quality in an observational cohort containing site-interpreted data. IE reproducibility was assessed on a subset of echocardiograms from subjects enrolled in the International Collaboration on Endocarditis registry. Specific echocardiographic case report forms were used. Intra-observer agreement was assessed from six site readers on ten randomly selected echocardiograms. Inter-observer agreement between sites and an echocardiography core laboratory was assessed on a separate random sample of 110 echocardiograms. Agreement was determined using intraclass correlation (ICC), coverage probability (CP), and limits of agreement for continuous variables and kappa statistics (κweighted) and CP for categorical variables. Intra-observer agreement for LVEF was excellent [ICC = 0.93 ± 0.1 and all pairwise differences for LVEF (CP) were within 10 %]. For IE categorical echocardiographic variables, intra-observer agreement was best for aortic abscess (κweighted = 1.0, CP = 1.0 for all readers). Highest inter-observer agreement for IE categorical echocardiographic variables was obtained for vegetation location (κweighted = 0.95; 95 % CI 0.92–0.99) and lowest agreement was found for vegetation mobility (κweighted = 0.69; 95 % CI 0.62–0.86). Moderate to excellent intra- and inter-observer agreement is observed for echocardiographic variables in the diagnostic assessment of IE. A pragmatic approach for determining echocardiographic data reproducibility in a large, multicentre, site interpreted observational cohort is feasible.
KeywordsEchocardiographic agreement Infective endocarditis Reproducibility Echocardiography core laboratory
This study was funded in part by a Danish-American Fulbright scholarship and grants from The Danish Heart Association to TKL (R97-R5249) and an American Society of Echocardiography Foundation grant to ALC (12-G-10-ASE). Neither entity was involved in the study design, the collection, analysis and interpretation of data, the writing of the report, or in the decision to submit the article for publication.
Compliance with ethical standards
Conflict of interest
TL, CS, ST, LA, EC, LP, EY, HXB, CP, DL, GP, ABS, MCJ, SD, ST, GH, PSD, ALC: No disclosures. ZS: Grant support-Boston Scientific. NB: Paid consultant-Leo Pharma, grant support-Novartis, Pfizer, Roche.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Authors/Task Force Members, Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, et al (2015) ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 36:3075–3123CrossRefGoogle Scholar
- 9.Lauridsen TK, Park L, Tong SY, Selton-Suty C, Peterson G, Cecchi E et al (2015) Echocardiographic findings predict in-hospital and 1-year mortality in left-sided native valve Staphylococcus aureus endocarditis: analysis from the International Collaboration on Endocarditis-Prospective Echo Cohort Study. Circ Cardiovasc Imaging 8(7):e003397CrossRefPubMedGoogle Scholar
- 10.Vilacosta I, Olmos C, de Agustín A, López J, Islas F, Sarriá C, Ferrera C, Ortiz-Bautista C, Sánchez-Enrique C, Vivas D, San Román A (2015) The diagnostic ability of echocardiography for infective endocarditis and its associated complications. Expert Rev Cardiovasc Ther 13(11):1225–1236. doi: 10.1586/14779072.2015.1096780 CrossRefPubMedGoogle Scholar
- 11.Cabell CH, Abrutyn E (2002) Progress toward a global understanding of infective endocarditis. Early lessons from the International Collaboration on Endocarditis Investigation. Infect Dis Clin N Am 16(2):255–272, viiGoogle Scholar
- 12.Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG Jr, Bayer AS et al (2009) Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 169(5):463–473CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Douglas PS, DeCara JM, Devereux RB, Duckworth S, Gardin JM, Jaber WA et al (2009) Echocardiographic imaging in clinical trials: American Society of Echocardiography Standards for echocardiography core laboratories: endorsed by the American College of Cardiology Foundation. J Am Soc Echocardiogr 22(7):755–765CrossRefPubMedGoogle Scholar
- 17.Laser KT, Bunge M, Hauffe P, Argueta JR, Kelter-Klopping A, Barth P et al (2010) Left ventricular volumetry in healthy children and adolescents: comparison of two different real-time three-dimensional matrix transducers with cardiovascular magnetic resonance. Eur J Echocardiogr 11(2):138–148CrossRefPubMedGoogle Scholar
- 19.Barnhart HX, Yow E, Crowley AL, Daubert MA, Rabineau D, Bigelow R et al (2014) Choice of agreement indices for assessing and improving measurement reproducibility in a core laboratory setting. Stat Methods Med Res. doi: 10.1177/0962280214534651
- 22.http://cvquality.acc.org/NCDR-Home/About-NCDR/Data-Quality.aspx. Cited 13 April 2015