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Echocardiographic agreement in the diagnostic evaluation for infective endocarditis

  • Trine Kiilerich Lauridsen
  • Christine Selton-Suty
  • Steven Tong
  • Luis Afonso
  • Enrico Cecchi
  • Lawrence Park
  • Eric Yow
  • Huiman X. Barnhart
  • Carlos Paré
  • Zainab Samad
  • Donald Levine
  • Gail Peterson
  • Amy Butler Stancoven
  • Magnus Carl Johansson
  • Stuart Dickerman
  • Syahidah Tamin
  • Gilbert Habib
  • Pamela S. Douglas
  • Niels Eske Bruun
  • Anna Lisa Crowley
Original Paper

Abstract

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.

Keywords

Echocardiographic agreement Infective endocarditis Reproducibility Echocardiography core laboratory 

Notes

Acknowledgments

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10554_2016_873_MOESM1_ESM.pdf (198 kb)
Supplementary material 1 (PDF 198 KB)

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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Trine Kiilerich Lauridsen
    • 1
    • 2
  • Christine Selton-Suty
    • 3
  • Steven Tong
    • 4
  • Luis Afonso
    • 5
  • Enrico Cecchi
    • 6
  • Lawrence Park
    • 1
  • Eric Yow
    • 7
  • Huiman X. Barnhart
    • 7
  • Carlos Paré
    • 8
  • Zainab Samad
    • 1
  • Donald Levine
    • 5
  • Gail Peterson
    • 9
  • Amy Butler Stancoven
    • 10
    • 11
  • Magnus Carl Johansson
    • 12
  • Stuart Dickerman
    • 13
  • Syahidah Tamin
    • 14
  • Gilbert Habib
    • 15
  • Pamela S. Douglas
    • 1
    • 7
  • Niels Eske Bruun
    • 2
    • 16
  • Anna Lisa Crowley
    • 1
    • 7
  1. 1.Department of MedicineDuke University Medical CenterDurhamUSA
  2. 2.Department of CardiologyGentofte and Herlev University HospitalCopenhagenDenmark
  3. 3.Cardiology DepartmentCHU Nancy-BraboisNancyFrance
  4. 4.Charles Darwin UniversityDarwinAustralia
  5. 5.Division of CardiologyWayne State University School of MedicineDetroitUSA
  6. 6.Department of CardiologyMaria Vittoria HospitalTurinItaly
  7. 7.Duke Clinical Research InstituteDurhamUSA
  8. 8.Department of Cardiology, Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  9. 9.Department of MedicineUT-Southwestern Medical CenterDallasUSA
  10. 10.Department of CardiologyBaylor, Scott & White HealthcareRound RockUSA
  11. 11.Department of MedicineTexas A&M Health Science Center College of MedicineBryanUSA
  12. 12.Department of MedicineSahlgrenska University HospitalGothenburgSweden
  13. 13.Internal MedicineNew York University Medical CenterNew YorkUSA
  14. 14.Department of CardiologyUniversity of Malaya Medical CentreKuala LumpurMalaysia
  15. 15.Faculté de Médecine de MarseilleMarseilleFrance
  16. 16.Department of MedicineAalborg UniversityAalborgDenmark

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