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Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: a comparison of subjective and novel objective methodology.

Nickolay, Thomas; McGregor, Gordon; Powell, Richard; Begg, Brian; Birkett, Stefan; Nichols, Simon; Ennis, Stuart; Banerjee, Prithwish; Shave, Rob; Metcalfe, James; Hoye, Angela; Ingle, Lee

Authors

Thomas Nickolay

Gordon McGregor

Richard Powell

Brian Begg

Stefan Birkett

Stuart Ennis

Prithwish Banerjee

Rob Shave

James Metcalfe

Angela Hoye

Lee Ingle



Abstract

Cardiopulmonary exercise testing (CPET) is the 'gold standard' method for evaluating functional capacity, with oxygen pulse (O2Pulse) inflections serving as a potential indicator of myocardial ischaemia. However, the reliability and agreement of identifying these inflections have not been thoroughly investigated. This study aimed to assess the inter- and intra-observer reliability and agreement of a subjective quantification method for identifying O2Pulse inflections during CPET, and to propose a more robust and objective novel algorithm as an alternative methodology. A retrospective analysis was conducted using baseline data from the HIIT or MISS UK trial. The O2Pulse curves were visually inspected by two independent examiners, and compared against an objective algorithm. Fleiss' Kappa was used to determine the reliability of agreement between the three groups of observations. The results showed almost perfect agreement between the algorithm and both examiners, with a Fleiss' Kappa statistic of 0.89. The algorithm also demonstrated excellent inter-rater reliability (ICC) when compared to both examiners (0.92-0.98). However, a significant level (P ≤0.05) of systematic bias was observed in Bland-Altman analysis for comparisons involving the novice examiner. In conclusion, this study provides evidence for the reliability of both subjective and novel objective methods for identifying inflections in O2Pulse during CPET. These findings suggest that further research into the clinical significance of O2Pulse inflections is warranted, and that the adoption of a novel objective means of quantification may be preferable to ensure equality of outcome for patients.

Citation

NICKOLAY, T., MCGREGOR, G., POWELL, R., BEGG, B., BIRKETT, S., NICHOLS, S., ENNIS, S., BANERJEE, P., SHAVE, R., METCALFE, J., HOYE, A. and INGLE, L. 2024. Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: a comparison of subjective and novel objective methodology. PLoS one [online], 19(3), article number e0299486. Available from: https://doi.org/10.1371/journal.pone.0299486

Journal Article Type Article
Acceptance Date Feb 10, 2024
Online Publication Date Mar 7, 2024
Publication Date Mar 31, 2024
Deposit Date Mar 21, 2024
Publicly Available Date Mar 21, 2024
Journal PLoS ONE
Print ISSN 1932-6203
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 19
Issue 3
Article Number e0299486
DOI https://doi.org/10.1371/journal.pone.0299486
Keywords Algorithms; Heart rate; Exercise; Ischemia; Coronary heart disease; Oxygen; Peak values
Public URL https://rgu-repository.worktribe.com/output/2262438

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NICKOLAY 2024 Inter- and intra-observer (VOR) (12.5 Mb)
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Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
© 2024 Nickolay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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