This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Koch, R. Articles by Mor-Avi, V. Search for Related Content PubMed PubMed Citation Articles by Koch, R. Articles by Mor-Avi, V.

CLINICAL STUDIES

Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images

^a Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, Chicago, Illinois, USA

Manuscript received July 2, 1998; revised manuscript received March 25, 1999, accepted April 30, 1999.

Reprint requests and correspondence: Victor Mor-Avi, PhD, University of Chicago Medical Center, M.C. 5084, 5841 S. Maryland Ave., Chicago, Illinois 60637
vmoravi{at}medicine.bsd.uchicago.edu

OBJECTIVES

To test the feasibility of objective and automated evaluation of echocardiographic stress tests, we studied the ability of segmental analysis of color kinesis (CK) images to detect dobutamine-induced wall motion abnormalities and compared this technique with inexperienced reviewers of conventional gray-scale images.

BACKGROUND

Conventional interpretation of stress echocardiographic studies is subjective and experience dependent.

METHODS

CK images were obtained in 89 of 104 consecutive patients undergoing clinical dobutamine stress studies and were analyzed using custom software to calculate regional fractional area change in 22 segments in four standard views. Each patient’s data obtained at rest was used as a control for automated detection of dobutamine-induced wall motion abnormalities. Independently, studies were reviewed without CK overlays by two inexperienced readers who classified each segment’s response to dobutamine. A consensus reading of two experienced reviewers was used as the gold standard for comparisons. In a subgroup of 16 patients, these consensus readings and CK detection of wall motion abnormalities were compared with coronary angiography.

RESULTS

The consensus reading detected ischemic response to dobutamine in 43 of 1958 segments in 23 of 89 patients. Automated detection of stress-induced wall motion abnormalities correlated more closely with the standard technique than the inexperienced reviewers (sensitivity 0.76 vs. 0.55, specificity 0.98 vs. 0.94 and accuracy 0.97 vs. 0.92). When compared with coronary angiography in a subgroup of patients, analysis of CK images differentiated between normal and abnormal wall motion more accurately than expert readers of gray-scale images (accuracy of 0.93 vs. 0.82).

CONCLUSIONS

Analysis of CK images allows fast, objective and automated evaluation of regional wall motion, sensitive enough for clinical dobutamine stress data and more accurate than inexperienced readers. This method may result in a valuable adjunct to conventional visual interpretation of dobutamine stress echocardiography.

Abbreviations and Acronyms   CAD = coronary artery disease   LV = left ventricular

This article has been cited by other articles:

				L. Hanekom, G.-Y. Cho, R. Leano, L. Jeffriess, and T. H. Marwick Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation Eur. Heart J., July 2, 2007; 28(14): 1765 - 1772. [Abstract] [Full Text] [PDF]

				M Becker, E Bilke, H Kuhl, M Katoh, R Kramann, A Franke, A Bucker, P Hanrath, and R Hoffmann Analysis of myocardial deformation based on pixel tracking in two dimensional echocardiographic images enables quantitative assessment of regional left ventricular function Heart, August 1, 2006; 92(8): 1102 - 1108. [Abstract] [Full Text] [PDF]

				V. Mor-Avi, L. Sugeng, R. J. Weiss, E. Toledo, L. Weinert, T. Bouchard, K. T. Spencer, and R. M. Lang Computerized evaluation of echocardiographic stress tests in patients with poorly visualized endocardium using analysis of color-encoded contrast-enhanced images Eur J Echocardiogr, March 1, 2006; 7(2): 122 - 133. [Abstract] [Full Text] [PDF]

				T H Marwick Techniques for comprehensive two dimensional echocardiographic assessment of left ventricular systolic function Heart, November 1, 2003; 89(90003): iii2 - 8. [Full Text] [PDF]

				C.F Madler, N Payne, U Wilkenshoff, A Cohen, G.A Derumeaux, L.A Pierard, J Engvall, L-A Brodin, G.R Sutherland, A.G Fraser, et al. Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography: optimal diagnostic models using off-line tissue Doppler in the MYDISE study Eur. Heart J., September 1, 2003; 24(17): 1584 - 1594. [Abstract] [Full Text] [PDF]

				S Carstensen, U Host, K Saunamaki, and H Kelbaek Quantitative analysis of dobutamine-atropine stress echocardiography Eur J Echocardiogr, September 1, 2003; 4(3): 169 - 177. [Abstract] [Full Text] [PDF]

				M. V. Podgoreanu, G. N. Djaiani, E. Davis, B. Phillips-Bute, and J. P. Mathew Quantitative Echocardiographic Assessment of Regional Wall Motion and Left Ventricular Asynchrony with Color Kinesis in Cardiac Surgery Patients Anesth. Analg., May 1, 2003; 96(5): 1294 - 1300. [Abstract] [Full Text] [PDF]

				T. Kukulski, F. Jamal, L. Herbots, J. D'hooge, B. Bijnens, L. Hatle, I. De Scheerder, and G. R. Sutherland Identification of acutely ischemic myocardium using ultrasonic strain measurements: A clinical study in patients undergoing coronary angioplasty J. Am. Coll. Cardiol., March 5, 2003; 41(5): 810 - 819. [Abstract] [Full Text] [PDF]

				F. Weidemann, C. Dommke, B. Bijnens, P. Claus, J. D'hooge, P. Mertens, E. Verbeken, A. Maes, F. Van de Werf, I. De Scheerder, et al. Defining the Transmurality of a Chronic Myocardial Infarction by Ultrasonic Strain-Rate Imaging: Implications for Identifying Intramural Viability: An Experimental Study Circulation, February 18, 2003; 107(6): 883 - 888. [Abstract] [Full Text] [PDF]

				R. Hoffmann, T.H. Marwick, D. Poldermans, H. Lethen, R. Ciani, P. van der Meer, H.-P. Tries, P. Gianfagna, P. Fioretti, J.J. Bax, et al. Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms Eur. Heart J., May 2, 2002; 23(10): 821 - 829. [Abstract] [Full Text] [PDF]

				G I W Galasko, S Basu, A Lahiri, and R Senior A prospective comparison of echocardiographic wall motion score index and radionuclide ejection fraction in predicting outcome following acute myocardial infarction Heart, September 1, 2001; 86(3): 271 - 276. [Abstract] [Full Text] [PDF]

				F. Jamal, J. Strotmann, F. Weidemann, T. Kukulski, J. D'hooge, B. Bijnens, F. Van de Werf, I. De Scheerder, and G. R. Sutherland Noninvasive Quantification of the Contractile Reserve of Stunned Myocardium by Ultrasonic Strain Rate and Strain Circulation, August 28, 2001; 104(9): 1059 - 1065. [Abstract] [Full Text] [PDF]

				V. Mor-Avi, K. A. Collins, C. E. Korcarz, M. Shah, K. T. Spencer, and R. M. Lang Detection of regional temporal abnormalities in left ventricular function during acute myocardial ischemia Am J Physiol Heart Circ Physiol, April 1, 2001; 280(4): H1770 - H1781. [Abstract] [Full Text] [PDF]

				V. Mor-Avi, K. Spencer, J. Gorcsan, A. Demaria, T. Kimball, M. Monaghan, J. Perez, J. P. Sun, L. Weinert, J. Bednarz, et al. Normal values of regional left ventricular endocardial motion: multicenter color kinesis study Am J Physiol Heart Circ Physiol, November 1, 2000; 279(5): H2464 - H2476. [Abstract] [Full Text] [PDF]

				L. Hatle and G. R. Sutherland Regional myocardial function--a new approach. Eur. Heart J., August 1, 2000; 21(16): 1337 - 1357. [PDF]