Inter-observer differences in interpretation of coronary pressure-wire pullback data by non-expert interventional cardiologists View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2020-05-19

AUTHORS

Takayuki Warisawa, James P. Howard, Christopher M. Cook, Yousif Ahmad, Shunichi Doi, Masafumi Nakayama, Sonoka Goto, Yohei Yakuta, Kenichi Karube, Fumiyasu Seike, Teruyoshi Uetani, Tadashi Murai, Yuetsu Kikuta, Yasutsugu Shiono, Yoshiaki Kawase, Matthew J. Shun-Shin, Toshiki Kaihara, Takumi Higuma, Yuki Ishibashi, Hisao Matsuda, Hidetaka Nishina, Hitoshi Matsuo, Javier Escaned, Yoshihiro J. Akashi, Justin E. Davies

ABSTRACT

The physiological pattern of coronary artery disease as determined by pressure-wire (PW)-pullback is important for decision-making of revascularization and risk stratification of patients. However, it remains unclear whether inter-observer differences in interpreting PW-pullback data are subject to the expertise of physicians. This study sought to investigate the subjectivity of this assessment among non-experts. Expert interventional cardiologists classified 545 PW-pullback traces into physiologically focal or physiologically diffuse disease pattern. Defining expert-consensus as the reference standard, we evaluated ten non-expert doctors’ classification performance. Observers were stratified equally by two ways: (i) years of experience as interventional cardiologists (middle-level vs. junior-level) and (ii) volume of institutions where they belonged to (high-volume center vs. low-volume center). When judged against the expert-consensus, the agreement of non-expert observers in assessing physiological pattern of disease (focal or diffuse) ranged from 69.1 to 85.0% (p for heterogeneity < 0.0001). There was no evidence for a moderating effect of years of experience; the pooled accuracy of middle-level doctors was 78.8% (95% confidential interval [CI] 72.8–84.7%) vs. 79.1% for junior-level doctors (95% CI 75.9–82.2%, p = 0.95 for difference). On the other hand, we observed a significant moderating effect of center volume. Accuracy across non-experts in high-volume centers was 82.7% (95% CI 80.3–85.1%) vs. 75.1% for low-volume centers (95% CI 71.9–78.3%, p = 0.0002 for difference). Interpretation of PW-pullback by non-expert interventional cardiologists was considerably subjective. More... »

PAGES

289-297

Journal

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12928-020-00673-3

DOI

http://dx.doi.org/10.1007/s12928-020-00673-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1127725305

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32430763


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    "description": "The physiological pattern of coronary artery disease as determined by pressure-wire (PW)-pullback is important for decision-making of revascularization and risk stratification of patients. However, it remains unclear whether inter-observer differences in interpreting PW-pullback data are subject to the expertise of physicians. This study sought to investigate the subjectivity of this assessment among non-experts. Expert interventional cardiologists classified 545 PW-pullback traces into physiologically focal or physiologically diffuse disease pattern. Defining expert-consensus as the reference standard, we evaluated ten non-expert doctors\u2019 classification performance. Observers were stratified equally by two ways: (i) years of experience as interventional cardiologists (middle-level vs. junior-level) and (ii) volume of institutions where they belonged to (high-volume center vs. low-volume center). When judged against the expert-consensus, the agreement of non-expert observers in assessing physiological pattern of disease (focal or diffuse) ranged from 69.1 to 85.0% (p for heterogeneity\u2009<\u20090.0001). There was no evidence for a moderating effect of years of experience; the pooled accuracy of middle-level doctors was 78.8% (95% confidential interval [CI] 72.8\u201384.7%) vs. 79.1% for junior-level doctors (95% CI 75.9\u201382.2%, p\u2009=\u20090.95 for difference). On the other hand, we observed a significant moderating effect of center volume. Accuracy across non-experts in high-volume centers was 82.7% (95% CI 80.3\u201385.1%) vs. 75.1% for low-volume centers (95% CI 71.9\u201378.3%, p\u2009=\u20090.0002 for difference). Interpretation of PW-pullback by non-expert interventional cardiologists was considerably subjective.", 
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343 grid-institutes:grid.411068.a schema:alternateName Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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346 grid-institutes:grid.412764.2 schema:alternateName Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashi-Cho, Asahi-Ku, 241-0811, Yokohama, Kanagawa, Japan
347 Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
348 schema:name Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashi-Cho, Asahi-Ku, 241-0811, Yokohama, Kanagawa, Japan
349 Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
350 Hammersmith Hospital, Imperial College London, London, UK
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352 grid-institutes:grid.412857.d schema:alternateName Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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355 grid-institutes:grid.415159.d schema:alternateName Division of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan
356 schema:name Division of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan
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358 grid-institutes:grid.417324.7 schema:alternateName Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
359 schema:name Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
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361 grid-institutes:grid.511555.0 schema:alternateName Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
362 schema:name Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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364 grid-institutes:grid.5650.6 schema:alternateName AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands
365 schema:name AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands
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367 grid-institutes:grid.7445.2 schema:alternateName Hammersmith Hospital, Imperial College London, London, UK
368 schema:name Hammersmith Hospital, Imperial College London, London, UK
369 rdf:type schema:Organization
 




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