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Observer Reproducibility and Validity of Systems for
Clinical Classification of Stable Angina Pectoris Patients
HW Christensen, W Vach, T Haghfelt, PF Høilund-Carlsen
Departments of Nuclear Medicine and Cardiology, Odense University Hospital,
Department of Statistics, University of Southern Denmark, Denmark
Objective
Results
To elucidate the reproducibility and validity of
commonly used systems for clinical
classification of patients with stable angina
pectoris.
Observers agreed 100% on the presence (n=45) or
absence (n=11) of angina. Further, they agreed in 52
(93%), 48 (86%), and 42 (75%) patients with regard to
type of angina, CCS grade, and NYHA class,
respectively. In the remaining patients, they
disagreed by one class only. The positive and
negative predictive values of clinical angina (typical
or atypical) for perfusion abnormalities were 55% and
82%, respectively (fig 1A), and for coronary artery
disease 53% and 47%, respectively (fig 1B). There
was no close relationship between the type or the
severity of pain and the perfusion pattern, nor
between VAS and CCS gradings, or NYHA class and
ejection fraction.
Background
Despite their frequent use these systems have
rarely been tested with regard to reproducibility
or against a suitable reference.
Materials and Methods
Figure 1A:
Angina type versus myocardial perfusion imaging
30
15
20
10
2
4
MPI
10
9
Irreversibel
7
5
Reversibel
0
A total of 56 patients scheduled for coronary
angiography because of stable angina pectoris
were classified clinically by two independent
observers with regard to 1) type (no chest pain,
non-cardiac pain, atypical angina, typical angina)
and 2) severity (Canadian Cardiovascular Society
Class (CCS) of chest pain as well as 3) cardiac
functional status (New York Heart Association
(NYHA)). Myocardial perfusion imaging was
carried out later on the same day in 55 patients
including measurement of left ventricular ejection
fraction in 46. Coronary angiography was
undertaken later (mean 2.3 months) in 51.
Conclusion
Observers agreed surprisingly well with regard to
presence, type, and severity of angina pectoris, and
less well with respect to cardiac functional status.
Clincal prediction of myocardial perfusion pattern was
inaccurate, and clinical judgments and objective
recordings were not interrelated.
Normal
No angina
Atypical angina
Non-cardiac
Typical angina
Figure 1B:
Angina type versus coronary angiography
30
5
20
2
4
CAG
10
3
2
11
3VD
4
8
2VD
6
5
1VD
0
No CAD
No angina
Contact: [email protected]
Atypical angina
Non-cardiac angina
Typical angina