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Review
. 2022 Nov 29;12(12):2993.
doi: 10.3390/diagnostics12122993.

Assessing Agreement When Agreement Is Hard to Assess-The Agatston Score for Coronary Calcification

Kristoffer Papsø Andersen  1 , Oke Gerke  1   2
Affiliations
Review

Assessing Agreement When Agreement Is Hard to Assess-The Agatston Score for Coronary Calcification

Kristoffer Papsø Andersen et al. Diagnostics (Basel). .

Abstract

Method comparison studies comprised simple scatterplots of paired measurements, a 45-degree line as benchmark, and correlation coefficients up to the advent of Bland-Altman analysis in the 1980s. The Agatston score for coronary calcification is based on computed tomography of the heart, and it originated in 1990. A peculiarity of the Agatston score is the often-observed skewed distribution in screening populations. As the Agatston score has manifested itself in preventive cardiology, it is of interest to investigate how reproducibility of the Agatston score has been established. This review is based on literature findings indexed in MEDLINE/PubMed before 20 November 2021. Out of 503 identified articles, 49 papers were included in this review. Sample sizes were highly variable (10-9761), the main focus comprised intra- and interrater as well as intra- and interscanner variability assessments. Simple analysis tools such as scatterplots and correlation coefficients were successively supplemented by first difference, later Bland-Altman plots; however, only very few publications were capable of deriving Limits of Agreement that fit the observed data visually in a convincing way. Moreover, several attempts have been made in the recent past to improve the analysis and reporting of method comparison studies. These warrant increased attention in the future.

Keywords: Bland–Altman; agreement; calcium; computed tomography; difference plot; heart; method comparison; quantitative; repeatability; reproducibility.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
PRISMA flowchart [10].
Figure 1
Figure 1
Type of CT scanner technology used in the included studies.
Figure 2
Figure 2
Boxplots for sample size by type of reproducibility assessment, excluding studies with more than 1000 observations [37,40,41,44,58] for better comparability.
Figure 3
Figure 3
Plot shows a fictive distribution of differences between repeated Agatston scores. Curve shows 95% repeatability limits based on nonparametric quantile regression as applied in [40,58].
See this image and copyright information in PMC

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