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Echocardiographic agreement in the diagnostic evaluation for infective endocarditis

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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.

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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.

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Authors and Affiliations

  1. Department of Medicine, Duke University Medical Center, Box 2805, Durham, NC, 27710, USA

    Trine Kiilerich Lauridsen, Lawrence Park, Zainab Samad, Pamela S. Douglas & Anna Lisa Crowley

  2. Department of Cardiology, Gentofte and Herlev University Hospital, Copenhagen, Denmark

    Trine Kiilerich Lauridsen & Niels Eske Bruun

  3. Cardiology Department, CHU Nancy-Brabois, Nancy, France

    Christine Selton-Suty

  4. Charles Darwin University, Darwin, NT, Australia

    Steven Tong

  5. Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA

    Luis Afonso & Donald Levine

  6. Department of Cardiology, Maria Vittoria Hospital, Turin, Italy

    Enrico Cecchi

  7. Duke Clinical Research Institute, Durham, NC, USA

    Eric Yow, Huiman X. Barnhart, Pamela S. Douglas & Anna Lisa Crowley

  8. Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Carlos Paré

  9. Department of Medicine, UT-Southwestern Medical Center, Dallas, USA

    Gail Peterson

  10. Department of Cardiology, Baylor, Scott & White Healthcare, Round Rock, TX, USA

    Amy Butler Stancoven

  11. Department of Medicine, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA

    Amy Butler Stancoven

  12. Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden

    Magnus Carl Johansson

  13. Internal Medicine, New York University Medical Center, New York, USA

    Stuart Dickerman

  14. Department of Cardiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia

    Syahidah Tamin

  15. Faculté de Médecine de Marseille, Marseille, France

    Gilbert Habib

  16. Department of Medicine, Aalborg University, Aalborg, Denmark

    Niels Eske Bruun

Authors
  1. Trine Kiilerich Lauridsen
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  2. Christine Selton-Suty
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  3. Steven Tong
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  4. Luis Afonso
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  5. Enrico Cecchi
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  6. Lawrence Park
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  7. Eric Yow
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  8. Huiman X. Barnhart
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  9. Carlos Paré
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  10. Zainab Samad
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  11. Donald Levine
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  12. Gail Peterson
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  13. Amy Butler Stancoven
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  14. Magnus Carl Johansson
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  15. Stuart Dickerman
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  16. Syahidah Tamin
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  17. Gilbert Habib
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  18. Pamela S. Douglas
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  19. Niels Eske Bruun
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  20. Anna Lisa Crowley
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Corresponding author

Correspondence to Anna Lisa Crowley.

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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.

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

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Lauridsen, T.K., Selton-Suty, C., Tong, S. et al. Echocardiographic agreement in the diagnostic evaluation for infective endocarditis. Int J Cardiovasc Imaging 32, 1041–1051 (2016). https://doi.org/10.1007/s10554-016-0873-5

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  • DOI: https://doi.org/10.1007/s10554-016-0873-5

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