Copyright © 1999 by the European Society of Cardiology.
Madness and method in stress echo reading
Institute of Clinical Physiology, Pisa, Italy
Cardiovascular Unit, Guastalla Hospital, Reggio Emilia, Italy
Cardiology Department, S.M.N. Hospital, Reggio Emilia, Italy
revised January 26, 1999; accepted February 3, 1999
Abstract
Aim To assess whether ‘eye education’ through short-term, high-intensity joint reading sessions may improve diagnostic accuracy and inter-observer agreement among beginners.
Methods and Results Seventeen cardiologists with absent to minimal (<100 studies performed) previous stress echo experience independently and blindly read 18 stress echo studies, nine at the beginning (‘pre-training’ set) and nine at the end (‘post-training’ set) of a 2 day stress echo school which included a joint reading session of 50 tapes. The two sets were balanced as far as type of stress and image quality. The 17 observers had an average accuracy score of 51±16·4 before and 64·3±8·7% after the training (P<0·005). Concordant (i.e. >14 readers giving the same response) interpretation occurred in three out of nine studies before and in eight out of nine studies after the training (33% vs 88%,P<0·01). Kappa values went from 0·14 (poor) before to 0·39 (fair, close to moderate) after the training.
Conclusion Short-term, high-intensity dedicated training in stress echo, with joint reading sessions and consensus development of reading criteria significantly increased accuracy and markedly reduced the inter-observer variability in the reading of stress echos by beginners. If there is a Shakespearean madness in stress echo reading, ‘yet there is a method in’t’ (Hamlet, II, II, 205–206).
Key Words: Agreement, stress echo, variability
f1 Correspondence: Albert Varga, MD, Institute of Clinical Physiology, Pisa, CNR Via Paolo Savi, 8, 56123 Pisa, Italy.
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