Quality control of regional wall motion analysis in stress Echo 2020. (15th December 2017)

• Record Type: Journal Article
• Authors: Ciampi, Quirino; Picano, Eugenio; Paterni, Marco; Daros, Clarissa Borguezan; Simova, Iana; de Castro e Silva Pretto, José Luis; Scali, Maria Chiara; Gaibazzi, Nicola; Severino, Sergio; Djordjevic-Dikic, Ana; Kasprzak, Jaroslaw D.; Zagatina, Angela; Varga, Albert; Lowenstein, Jorge; Merlo, Pablo Martin; Amor, Miguel; Celutkiene, Jelena; Perez, Julio E.; Di Salvo, Giovanni; Galderisi, Maurizio; Mori, Fabio; Costantino, Marco Fabio; Massa, Laura; Dekleva, Milica; Chaves, Daniel Quesada; Trambaiolo, Paolo; Citro, Rodolfo; Colonna, Paolo; Rigo, Fausto; Torres, Marco A.R.; Monte, Ines; Stankovic, Ivan; Neskovic, Aleksander; Cortigiani, Lauro; Re, Federica; Dodi, Claudio; D'Andrea, Antonello; Villari, Bruno; Arystan, Ayana; De Nes, Michele; Carpeggiani, Clara;
• Is Part Of: International journal of cardiology. Volume 249(2017)
• Page Start: 479
• Page End: 485
• Publication Date: 2017-12-15
• Subjects: CAD1 coronary artery disease -- RWMA regional wall motion abnormalities -- SE stress echocardiography; Certification -- Quality control -- Stress echocardiography -- Wall motion; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.09.172
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. Methods: One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31 years (mean value 18 years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥ 90%). Results: Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7 ± 13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt ( r = − 0.161, p = 0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p < 0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt. Conclusions: In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit.