Quality control of B-lines analysis in stress Echo 2020

Giuseppina Novo, Suzana Gligorova, Carlos Cotrim, Karina Wierzbowska-Drabik, Ana Cristina Camarozano, Rodolfo Citro, Maciej Haberka, Angela Zagatina, Iana Simova, Fabio Mori, Eva Szymczyk, Anca Irina Corciu, Miodrag Ostojic, Jaroslaw D. Kasprzak, Aleksandar N. Neskovic, Marcelo Haertel Miglioranza, Alessandro Salustri, Miguel Amor, Katarzyna Wdowiak-Okrojek, Eduardo BossoneMarco Fabio Costantino, Lauro Cortigiani, Ines Monte, Maria Chiara Scali, Hugo Rodriguez-Zanella, Milica Dekleva, Maria Fiorino, Andrea Barbieri, Ana Djordjevic-Dikic, Pablo Martin Merlo, Clarissa Borguezan Daros, Clarissa Carmona De Azevedo Bellagamba, Daniel Quesada Chaves, Ivan Stankovic, Francesco Ferrara, Giovanni Di Salvo, Paolo Colonna, Maurizio Galderisi, Paulina Weiner-Mik, Alexandra Nikolic, Luis Ignacio Martin Leal, Antonello D'. Andrea, Bozena Sobkowic, Madalina-Loredana Urluescu, Tamara Preradovic-Kovacevic, Federica Re, Paolo Colonna, Michele De Nes, Jelena Čelutkiene, Piotr Gosciniak, José Luis De Castro E Silva Pretto, Paula Fazendas, Quirino Ciampi, Piotr Lipiec, Claudio Dodi, Paolo Trambaiolo, Alla Boshchenko, Nicola Gaibazzi, Barbara Reisenhofer, Branko Beleslin, Bruno Villari, Fausto Rigo, Giovanni Di Salvo, Marco Paterni, Tomasz Witkowski, Clara Carpeggiani, Alessandro Salustri, Maria Grazia Andreassi, Wojciech Kosmala, Fabio Lattanzi, Sergio Severino, Albert Varga, Eugenio Picano, Jorge Lowenstein, Marco A. R. Torres, Julio E. Perez, Giovanni Di Salvo, Maria Clara Fiorino

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3 Citations (Scopus)

Abstract

Background: The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose: To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods: 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module (http://se2020.altervista.org). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results: All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p <.01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p <.01). Conclusions: Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.
Original languageEnglish
Pages (from-to)20-
Number of pages9
JournalCardiovascular Ultrasound
Volume16
Publication statusPublished - 2018

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Novo, G., Gligorova, S., Cotrim, C., Wierzbowska-Drabik, K., Camarozano, A. C., Citro, R., Haberka, M., Zagatina, A., Simova, I., Mori, F., Szymczyk, E., Corciu, A. I., Ostojic, M., Kasprzak, J. D., Neskovic, A. N., Miglioranza, M. H., Salustri, A., Amor, M., Wdowiak-Okrojek, K., ... Fiorino, M. C. (2018). Quality control of B-lines analysis in stress Echo 2020. Cardiovascular Ultrasound, 16, 20-.