title: Standardized guidelines for the interpretation of dobutamine echocardiography reduce interinstitutional variance in interpretation.
abstract: Subjective interpretation of dobutamine echocardiograms provides only moderate interinstitutional observer agreement if nonunified data acquisition and assessment criteria are applied. The present study was undertaken to evaluate parameters associated with low interinstitutional observer agreement in the interpretation of dobutamine echocardiograms and to analyze whether standardized interpretation criteria improve interinstitutional observer agreement. One hundred fifty dobutamine echocardiograms (dobutamine up to 40 microg/kg/min body weight and atropine up to 1 mg) were evaluated at 5 centers. Clinical, procedural, and echocardiographic parameters were included in the analysis of variables with significant impact on interinstitutional agreement. Standardized interpretative criteria were established, and 90 dobutamine echocardiograms were reanalyzed by 3 observers using a standardized image display. Multivariate analysis demonstrated low image quality (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08 to 0.45, p=0.0002), low severity of induced wall motion abnormality (OR 0.17, 95% CI 0.07 to 0.40, p <0.0001), and a low peak rate-pressure product (OR 0.93, 95% CI 0.43 to 2.27, p=0.0382) to result in a low interinstitutional agreement. Standardization of image display in cine loop format and of dobutamine stress echo interpretation criteria resulted in improvement in test result categorization as normal or abnormal, with a kappa value of 0.50, compared with 0.39 using the original subjective interpretation. In conclusion, image quality, the severity of induced wall motion abnormalities, and the obtained rate-pressure product have a significant impact on the interpretation homogeneity of dobutamine echocardiograms. Standardization of image display in cine loop format and of reading criteria results in improved interinstitutional agreement in interpretation of stress echocardiograms.
authors.affiliation: Medical Clinic I, RWTH Aachen, Germany. rhof@pcserver.mk1.rwth-aachen.de
authors.forename: R
authors.initials: R
authors.lastname: Hoffmann
authors.forename: H
authors.initials: H
authors.lastname: Lethen
authors.forename: T
authors.initials: T
authors.lastname: Marwick
authors.forename: R
authors.initials: R
authors.lastname: Rambaldi
authors.forename: P
authors.initials: P
authors.lastname: Fioretti
authors.forename: A
authors.initials: A
authors.lastname: Pingitore
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: T
authors.initials: T
authors.lastname: Buck
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: F A
authors.initials: FA
authors.lastname: Flachskampf
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D005080:Exercise Test; D005260:Female; D005858:Germany; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D015588:Observer Variation; D016017:Odds Ratio; D009820:Ohio; D017410:Practice Guidelines as Topic
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine