title: Agreement is poor among current criteria used to define response to cardiac resynchronization therapy.
abstract: BACKGROUND
  Numerous criteria believed to define a positive response to cardiac resynchronization therapy have been used in the literature. No study has investigated agreement among these response criteria. We hypothesized that the agreement among the various response criteria would be poor.
  
  
  RESULTS
  A literature search was conducted with the keywords "cardiac resynchronization" and "response." The 50 publications with the most citations were reviewed. After the exclusion of editorials and reviews, 17 different primary response criteria were identified from 26 relevant articles. The agreement among 15 of these 17 response criteria was assessed in 426 patients from the Predictors of Response to Cardiac Resynchronization Therapy (PROSPECT) study with Cohen's kappa-coefficient (2 response criteria were not calculable from PROSPECT data). The overall response rate ranged from 32% to 91% for the 15 response criteria. Ninety-nine percent of patients showed a positive response according to at least 1 of the 15 criteria, whereas 94% were classified as a nonresponder by at least 1 criterion. kappa-Values were calculated for all 105 possible comparisons among the 15 response criteria and classified into standard ranges: Poor agreement (kappa< or =0.4), moderate agreement (0.4<kappa<0.75), and strong agreement (kappa> or =0.75). Seventy-five percent of the comparisons showed poor agreement, 21% showed moderate agreement, and only 4% showed strong agreement.
  
  
  CONCLUSIONS
  The 26 most-cited publications on predicting response to cardiac resynchronization therapy define response using 17 different criteria. Agreement between different methods to define response to cardiac resynchronization therapy is poor 75% of the time and strong only 4% of the time, which severely limits the ability to generalize results over multiple studies.
authors.affiliation: Emory University School of Medicine, Department of Radiology, Atlanta, GA 30322, USA. bkf@gatech.edu
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Fornwalt
authors.forename: William W
authors.initials: WW
authors.lastname: Sprague
authors.forename: Patrick
authors.initials: P
authors.lastname: BeDell
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Suever
authors.forename: Bart
authors.initials: B
authors.lastname: Gerritse
authors.forename: John D
authors.initials: JD
authors.lastname: Merlino
authors.forename: Derek A
authors.initials: DA
authors.lastname: Fyfe
authors.forename: Angel R
authors.initials: AR
authors.lastname: León
authors.forename: John N
authors.initials: JN
authors.lastname: Oshinski
mesh_terms: D002304:Cardiac Pacing, Artificial; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011237:Predictive Value of Tests; D014463:Ultrasonography