Not for the faint of heart: Cardiologists retract syncope paper after realizing data columns weren’t aligned right
The paper originally concluded that fainting spells (syncope) give patients with high blood pressure in their lung arteries poor prognoses, an observation that turned out to be incorrect.
The problem? The group merged two electronic databases, but did not align columns properly, a problem found only after first author Rachel Le revisited the dataset looking to cull more data.
Syncope in Adults With Pulmonary Arterial Hypertension. J Am Coll Cardiol 59 (2011) 863–7.
Rachel J. Le, MD, Eric R. Fenstad, MD, Hilal Maradit-Kremers, MD, Robert B. McCully, MD, Robert P. Frantz, MD, Michael D. McGoon, MD, Garvan C. Kane, MD, P HD.
Department of Medicine, Mayo Clinic, Rochester, Minnesota; and the Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Available online August 8, 2011.
Reason: This article has been retracted at the request of the authors, because of a data entry error, which is fundamental to the study findings. As background, this was a clinical study where a specific variable was tested in a large database. The process involved merging a variable (presence or absence of syncope) from one electronic source with an alternate electronic database of patients with pulmonary arterial hypertension and assessing associations and outcomes. In proceeding to design a follow-up study to this work, Dr. Le went back to the original source file to abstract new data. In doing this she identified a ‘cut-and paste’ error in which the column of syncope data was transferred incorrectly where syncope/no syncope variables were assigned to wrong subjects. This led to a critical error that then got carried forward and a fundamental misclassification of syncope in the final study group. This error fundamentally affects the results, which now do not fully support the conclusions.
The paper has been cited once, according to Thomson Scientific’s Web of Knowledge.
We’ve tried to contact Le and Kane for more information, and will update with anything we find out.
The Journal of the American College of Cardiology, like many journals, struggles with limited resources that allow errors to pass through, according to an April 17 editorial from Anthony N. DeMaria, the journal’s editor-in-chief. In “Scientific Misconduct, Retractions, and Errata”, DeMaria wrote:
If we can believe that over 10% of investigators are aware of scientific misconduct, either we as editors have been extraordinarily discerning of such transgressions during the review process, or we have occasionally been duped. This perhaps would not be surprising given the limited arsenal available to us to identify misconduct.
Kane’s group voluntarily came forward to admit their errors, and there was no misconduct reported.
The retraction also puts into question an abstract published in 2010 in Chest that had a similar conclusion to that of the JACC paper:
In a broad spectrum of clinical PAH patients, syncope is infrequent, associated with markers of right heart dysfunction and is strongly and independently predictive of poor outcome.
Cardiology Today featured the research on April 18, 2011 during its coverage of the The International Society for Heart & Lung Transplantation 31st annual meeting and scientific sessions. They quoted Le:
Presyncope/syncope is associated with markers of increased disease severity in newly diagnosed PAH patients. However, it was not predictive of unadjusted survival.
James Young, a Cardiology Today section editor, wrote a brief editorial to accompany the online article:
To me, the interesting aspect of this data was validation of something that has been repeatedly mentioned by astute clinicians of yesteryear: the relationship of presyncope and syncope to severity of PAH. It was an elegant analysis of an important registry and raises the question of a pathophysiologic link of syncope/presyncope to worsening PAH and not just something that is a consequence of PAH.