Standardized guidelines for the interpretation of dobutamine echocardiography reduce interinstitutional variance in interpretation

Subjective interpretation of dobutamine echocardiograms provides only moder ate interinstitutional observer agreement if nonunified data acquisition an d assessment criteria are applied. The present study was undertaken to eval uate parameters associated with low interinstitutional observer agreement i n the interpretation of dobutamine echocardiograms and to analyze whether s tandardized interpretation criteria improve interinstitutional observer agr eement. One hundred fifty dobutamine echocardiograms (dobutamine up to 40 m u g/kg/min body weight and atropine up to 1 mg) were evaluated at 5 centers . Clinical, procedural, and echocardiographic parameters were included in t he analysis of variables with significant impact on interinstitutional agre ement Standardized interpretative criteria were established, and 90 dobutam ine echocardiograms were reanalyzed by 3 observers using a standardized Ima ge display. Multivariate analysis demonstrated low image quality (odds rati o [OR] 0.19, 95% confidence interval [CI] 0.08 to 0.45, p = 0.0002), low se verity of induced wall motion abnormality (OR 0.17, 95% CI 0.07 to 0.40, p <0.0001), and a low peak rate-pressure product (OR 0.93, 95% CI 0.43 to 2.2 7, p = 0.0382) to result in a low interinstitutional agreement. Standardiza tion of image display in cine loop format and of dobutamine stress echo int erpretation criteria resulted in improvement in test result categorization as normal or abnormal, with a kappa value of 0.50, compared with 0.39 using the original subjective interpretation. In conclusion, image quality, the severity of induced wall motion abnormalities, and the obtained rate-pressu re product have a significant impact on the interpretation homogeneity of d obutamine echocardiograms. Standardization of image display in cine loop fo rmat and of reading criteria results in improved interinstitutional agreeme nt in interpretation of stress echocardiograms. (C) 1998 by Excerpta Medica , Inc.