Observer agreement in evaluating coronary angiograms.

Abstract

The reliability of interpretation of coronary arteriography as a diagnostic tool was investigated in a sub-study of the VA Cooperative Study of Surgical Treatment for Coronary Arterial Occlusive Disease. Twenty-two physicians with varying levels of experience read 13 cine angiograms -- blind -- on two different occasions. Analysis of inter- and intraobserver variability showed that angiographic items about which observers were most inconsistent from one reading to the other had the largest interobserver disagreement as well. They were the distal portions of the left anterior descending and left circumflex arteries. Among the items on which there was most consistent agreement -- namely, the right main coronary artery and presence of ventricular aneurysm -- there was most often agreement between observers as well. When individual readers were evaluated, some observers were far more consistent in their own readings of all the angiographic items than others. This intraobserver agreement in turn correlated fairly well with how often they agreed with the other observers and with how much experience they reported having in reading coronary cineangiograms.

Digital subtraction angiographic imaging of coronary flow reserve.

“…The increase in the peak value Cmax, which theoretically is due to changes in the vascular volume, and the decrease in the time of arrival Tan when contrast reaches the sampling point are evident. A model for flow that relates these two measured variables to coronary blood flow is described in Appendix 1, where it is demonstrated that, under certain conditions, the CONTRAST PASS CURVE LAD BED (2) The calculation of Cmax, TW, and the Q parameter can be implemented by digital image processing after selective injection by contrast into the coronary artery. The calculated values are then used to determine the flow ratio at every point in the image and an image of these values is produced.…”

Agreement in human interpretation of analog thallium myocardial perfusion images.

“…Imaging in each view was continued until a 2000-count information density (counts/cm2) was reached in the most normal portion of the left ventricular myocardium. This was approximately equivalent to 300,000-400,000 total counts and usually required [7][8][9][10] minutes of acquisition time per view. All analog scintigraphic images were unprocessed and recorded on x-ray transparent film.…”

Fase Piloto do Estudo SPECTRUM. Reserva de Fluxo Fracionada Versus Angiografia para Avaliação e Conduta em Pacientes com Lesões Obstrutivas Coronárias de Grau Moderado: Racional e Desenho do Estudo

“…3 A wide variability of visual estimates of gravity also occurs, usually documented by different examiners, as demonstrated by comparative studies of quantitative angiography. 4,5 Recently, studies correlating angiographic estimates of severity of coronary stenoses with intravascular ultrasonography performed during cardiac catheterization also showed difficulties in those angiographic evaluations, including on the elucidation of discrepant aspects regarding function assessment methods, such as myocardial perfusion scintigraphy. 6 Despite these limitations, angiography remains not only the gold-standard method, but also the most used and preferred method in determining approaches related to revascularization resulting from coronary lesions.…”