Abstract
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.
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Author Stephanie Minter, MS, RCS declares she has no conflict of interest. Author Alicia Armour MA, RDCS declares she has no conflict of interest. Author Amanda Tinnemore BS, RDCS declares she has no conflict of interest. Author Karen Strub BS, RDCS declares she has no conflict of interest. Author Anna Lisa Crowley, MD declares she has no conflict of interest. Author Gerald Bloomfield, MD, MPH declares he has no conflict of interest. Author John Alexander, MD, MHS declares he has no conflict of interest. Author Pamela Douglas, MD declares she has no conflict of interest. Author Joseph Kisslo, MD declares he is a speaker and consultant to Philips Ultrasound and GE Ultrasound and has grants from Medtronic and Novaseed. Author Eric Velazquez, MD declares he has no conflict of interest. Author Zainab Samad, MD, MHS declares she has no conflict of interest.
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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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Example of sample survey: https://duke.qualtrics.com/jfe/form/SV_eWiQf0creK96w1T.
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Minter, S., Armour, A., Tinnemore, A. et al. Crowdsourcing consensus: proposal of a novel method for assessing accuracy in echocardiography interpretation. Int J Cardiovasc Imaging 34, 1725–1730 (2018). https://doi.org/10.1007/s10554-018-1389-y
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DOI: https://doi.org/10.1007/s10554-018-1389-y