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Variabilidade inter-observador na interpretação de um Holter
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RESUMO - Introdução: O Holter é um meio complementar de diagnóstico e terapêutica cada vez
mais utilizado, com um papel fundamental na avaliação dos doentes com arritmias e no
esclarecimento de sintomatologia. A sua leitura está muito dependente do observador.
Por isso, achou-se interessante e porque não existe nada realizado nesse sentido,
avaliar se existe variabilidade significativa na interpretação de exames de Holter entre
três observadores.
Metodologia: O mesmo exame de Holter foi interpretado independentemente por três
técnicos superiores de diagnóstico e terapêutica, na área da Cardiopneumologia, os
quais no fim elaboraram um relatório. Deste, foram recolhidas as sete variáveis
categóricas, binárias em estudo. A concordância na classificação dessas variáveis entre
os observadores foi avaliada pelo coeficiente Cohen Kappa e Fleiss Kappa.
Resultados: Todos os observadores analisaram 130 exames de Holter e obtiveram pelo
Fleiss Kappa, uma concordância estatisticamente significativa (p<0,001) e quase
perfeita para as variáveis sístoles prematuras supraventriculares e ritmo sinusal (Kappa
varia entre 0,948 e 0,978), moderada para as variáveis sístoles prematuras
ventriculares, alterações da repolarização ventricular e tempo de condução
auriculoventricular (Kappa varia entre 0,639 e 0,722) e fraca para a variável variação
circadiana da frequência cardíaca (Kappa = 0,560). O Kappa não foi calculado para a
variável boa qualidade técnica do exame, por esta ser uma constante, no observador 1.
Conclusão: O estudo comprovou existir alguma variabilidade na interpretação de
exames de Holter entre os três observadores.
ABSTRACT - Introduction: Holter monitoring is a complementary means of diagnosis and therapy that is increasingly used, with a fundamental role in the evaluation of patients with arrhythmias and in clarifying symptoms. Its reading is very dependent on the observer. Therefore, it was found interesting and because nothing has been done in this subject, to assess if exists significant variability in the interpretation of Holter exams between three observers. Methodology: The same Holter exam was independently interpreted by three senior diagnostic and therapeutic technicians in the area of Cardiopneumology, who in the end prepared a report. From this, seven categorical, binary variables under study were collected. The agreement in the classification of these variables between all observers was evaluated using the Cohen Kappa and Fleiss Kappa coefficients. Results: All observers analyzed 130 Holter scans and obtained, using Fleiss Kappa, a statistically significant (p<0.001) and almost perfect agreement for the variables premature supraventricular systoles and sinus rhythm (Kappa varies between 0.948 and 0.978), moderate for the variables premature ventricular systoles, changes in ventricular repolarization and atrioventricular conduction time (Kappa varies between 0.639 and 0.722) and weak for the variable circadian heart rate variation (Kappa = 0.560). The Kappa was not calculated for the good technical quality of the test variable, as it is a constant in observer 1. Conclusion: The study proved that there is some variability in the interpretation of Holter exams among the three observers.
ABSTRACT - Introduction: Holter monitoring is a complementary means of diagnosis and therapy that is increasingly used, with a fundamental role in the evaluation of patients with arrhythmias and in clarifying symptoms. Its reading is very dependent on the observer. Therefore, it was found interesting and because nothing has been done in this subject, to assess if exists significant variability in the interpretation of Holter exams between three observers. Methodology: The same Holter exam was independently interpreted by three senior diagnostic and therapeutic technicians in the area of Cardiopneumology, who in the end prepared a report. From this, seven categorical, binary variables under study were collected. The agreement in the classification of these variables between all observers was evaluated using the Cohen Kappa and Fleiss Kappa coefficients. Results: All observers analyzed 130 Holter scans and obtained, using Fleiss Kappa, a statistically significant (p<0.001) and almost perfect agreement for the variables premature supraventricular systoles and sinus rhythm (Kappa varies between 0.948 and 0.978), moderate for the variables premature ventricular systoles, changes in ventricular repolarization and atrioventricular conduction time (Kappa varies between 0.639 and 0.722) and weak for the variable circadian heart rate variation (Kappa = 0.560). The Kappa was not calculated for the good technical quality of the test variable, as it is a constant in observer 1. Conclusion: The study proved that there is some variability in the interpretation of Holter exams among the three observers.
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Palavras-chave
Concordância Holter inter-observador variabilidade Cohen Kappa Fleiss Kappa Agreement Holter inter-observer variability