Echocardiographic agreement in the diagnostic evaluation for infective endocarditis.
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.
Department of Medicine, Duke University Medical Center, Box 2805, Durham, NC, 27710, USA.|Department of Cardiology, Gentofte and Herlev University Hospital, Copenhagen, Denmark.
Trine Kiilerich
TK
Lauridsen
Cardiology Department, CHU Nancy-Brabois, Nancy, France.
Christine
C
Selton-Suty
Charles Darwin University, Darwin, NT, Australia.
Steven
S
Tong
Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA.
Luis
L
Afonso
Department of Cardiology, Maria Vittoria Hospital, Turin, Italy.
Enrico
E
Cecchi
Department of Medicine, Duke University Medical Center, Box 2805, Durham, NC, 27710, USA.
Lawrence
L
Park
Duke Clinical Research Institute, Durham, NC, USA.
Eric
E
Yow
Duke Clinical Research Institute, Durham, NC, USA.
Huiman X
HX
Barnhart
Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Carlos
C
Paré
Department of Medicine, Duke University Medical Center, Box 2805, Durham, NC, 27710, USA.
Zainab
Z
Samad
Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA.
Donald
D
Levine
Department of Medicine, UT-Southwestern Medical Center, Dallas, USA.
Gail
G
Peterson
Department of Cardiology, Baylor, Scott & White Healthcare, Round Rock, TX, USA.|Department of Medicine, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA.
Amy Butler
AB
Stancoven
Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Magnus Carl
MC
Johansson
Internal Medicine, New York University Medical Center, New York, USA.
Stuart
S
Dickerman
Department of Cardiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Syahidah
S
Tamin
Faculté de Médecine de Marseille, Marseille, France.
Gilbert
G
Habib
Department of Medicine, Duke University Medical Center, Box 2805, Durham, NC, 27710, USA.|Duke Clinical Research Institute, Durham, NC, USA.
Pamela S
PS
Douglas
Department of Cardiology, Gentofte and Herlev University Hospital, Copenhagen, Denmark.|Department of Medicine, Aalborg University, Aalborg, Denmark.
Niels Eske
NE
Bruun
Department of Medicine, Duke University Medical Center, Box 2805, Durham, NC, 27710, USA. annalisa.crowley@duke.edu.|Duke Clinical Research Institute, Durham, NC, USA. annalisa.crowley@duke.edu.
Anna Lisa
AL
Crowley
D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
Echocardiographic agreement; Echocardiography core laboratory; Infective endocarditis; Reproducibility