title: Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intraobserver and interobserver reproducibility among experienced nuclear cardiologists and cardiology trainees.
abstract: BACKGROUND
  Stress electrocardiography (ECG)-gated single photon emission computed tomography (SPECT) for assessment of left ventricular perfusion and function improves the confidence of interpretation and enhances specificity for detection of coronary artery disease. The reproducibility of visual interpretation of ECG-gated SPECT images and the significance of training and experience have not been reported previously in a large series of consecutive patients. We evaluated both intraobserver and interobserver agreement of interpretation of ECG-gated SPECT images among 3 cardiology trainees and 3 experienced nuclear cardiologists from 3 institutions.
  
  
  RESULTS
  Three nuclear cardiologists and 3 cardiology trainees who had fulfilled American College of Cardiology/American Society of Nuclear Cardiology Core Cardiology Training Symposium (ACC/ASNC COCATS) guidelines for level II training in nuclear cardiology independently evaluated 106 consecutive technetium 99m sestamibi SPECT images with ECG gating of either the stress or rest images. All cases were interpreted blindly, twice in random sequence, without clinical data. We assessed intraobserver and interobserver agreement for myocardial perfusion, left ventricular regional and global systolic function, and overall clinical impression, by means of percent agreement and Cohen's kappa statistic. Intraobserver agreement was good (82%-92%, kappa = 0.54-0.84) for assessment of myocardial perfusion, systolic function, and overall impression. Interobserver agreement was also good, ranging from 65% to 90% (kappa = 0.32-0.76), with better agreement found for assessment of function (77%-85%, kappa = 0.52-0.7) than for perfusion (65%-80%, kappa = 0.32-0.6). For all measures, there were no significant differences in reproducibility between nuclear cardiologists and cardiology trainees.
  
  
  CONCLUSIONS
  Interpretation of ECG-gated SPECT images has high reproducibility and agreement among both nuclear cardiologists and cardiology trainees.
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Danias
authors.forename: Alan W
authors.initials: AW
authors.lastname: Ahlberg
authors.forename: Mark I
authors.initials: MI
authors.lastname: Travin
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Mahr
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Abreu
authors.forename: Dominic
authors.initials: D
authors.lastname: Marini
authors.forename: April
authors.initials: A
authors.lastname: Mann
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Mather
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.forename: Gary V
authors.initials: GV
authors.lastname: Heller
mesh_terms: D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi