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European Heart Journal Advance Access originally published online on April 13, 2006
European Heart Journal 2006 27(12):1459-1464; doi:10.1093/eurheartj/ehi883
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Determination of interobserver variability for identifying inducible left ventricular wall motion abnormalities during dobutamine stress magnetic resonance imaging

Ingo Paetsch1,*, Cosima Jahnke1, Victor A. Ferrari2, Frank E. Rademakers3, Patricia A. Pellikka4, W. Gregory Hundley5,6, Don Poldermans7, Jeroen J. Bax8, Karl Wegscheider9, Eckart Fleck1 and Eike Nagel1

1 Department of Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
2 Department of Medicine, Cardiovascular Medicine Division, University of Pennsylvania Medical School, Pennsylvania, PA, USA
3 Department of Cardiology, Gasthuisberg University Hospital, Leuven, Belgium
4 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, MN, USA
5 Department of Internal Medicine/Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina, NC, USA
6 Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, NC, USA
7 Department of Cardiology, Thorax Center Rotterdam, The Netherlands
8 Department of Cardiology, Leiden University Medical Center, The Netherlands
9 Institute for Statistics and Econometry, University of Hamburg, Hamburg, Germany

Received 17 October 2005; revised 28 February 2006; accepted 23 March 2006; online publish-ahead-of-print 13 April 2006.

* Corresponding author. Tel: +49 30 4593 2457; fax: +49 30 4593 2458. E-mail address: paetsch{at}dhzb.de

See page 1394 for the editorial comment on this article (doi:10.1093/eurheartj/ehl047)

Aims To determine the interobserver variability for identifying inducible left ventricular (LV) wall motion abnormalities during high-dose dobutamine/atropine stress cardiovascular magnetic resonance (DSMR).

Methods and results Four readers from various institutions were supplied with the image data from 150 consecutive DSMR examinations and asked to grade wall motion and image quality throughout graded doses of dobutamine infusion administered to achieve 85% of the maximum age-predicted heart rate. Inducible ischaemia was identified if more than one segment demonstrated a new or worsening LV wall motion abnormality, and significant stenosis was defined as ≥50% luminal diameter reduction by quantitative contrast coronary angiography. Seventy-seven patients (51%) had luminal narrowings ≥50%. Diagnostic performance (sensitivity, specificity, diagnostic accuracy) of all readers was 78.2, 87.0 and 82.5%. Disagreement between two readers occurred in every seventh examination. Agreement on the presence or absence of inducible wall motion abnormalities was moderate (mean kappa value 0.59, range 0.52–0.76). Diagnostic performance and disagreement were independent of the presence of luminal narrowings ≥50% or the number of diseased coronary vessels. Image quality was regarded excellent in 89.3% of standard views.

Conclusion In the setting of multiple observers from different institutions performing a diagnostic reading of DSMR examinations carried out at a single centre, the interobserver variability was low for identifying inducible LV wall motion abnormalities indicative of coronary arterial luminal narrowings ≥50%.

Key Words: Cardiac magnetic resonance imaging • Dobutamine stress • Wall motion analysis • Reader variability


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