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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

View larger version (13K): [in a new window]   Figure 1 Segmentation schemes used for analysis of endocardial wall motion (see text). (A) Short-axis view (SAX): ant = anterior, asp = anteroseptal, sp = septal, inf = inferior, pst = posterior, lat = lateral. (B) apical four-chamber view (A4C): b-lt = basal lateral, m-lt = mid-lateral, a-lt = apical-lateral, a-sp = apical-septal, m-sp = mid-septal, b-sp = basal-septal. (C) Apical two-chamber view (A2C): b-an = basal-anterior, m-an = mid-anterior, a-an = apical-anterior, a-in = apical-inferior, m-in = mid-inferior, b-in = basal-inferior. (D) Parasternal long axis view: b-asp = basal anteroseptal, m-asp = mid-anteroseptal, m-pst = mid-posterior, b-pst = basal posterior.

View larger version (93K): [in a new window]   Figure 2 Example of end-systolic color kinesis images obtained in a normal participant at rest (top), low dose (center), and peak dose of dobutamine infusion (bottom) in the parasternal short axis (SAX), apical four- and two-chamber (A4C and A2C) and parasternal long axis (LAX) views. See text for details.

View larger version (61K): [in a new window]   Figure 3 Stacked color histograms of regional fractional area change obtained from images in Figure 2. Each layer of these histograms represents incremental fractional area change that occurred during a 33-ms period of time, with earliest motion being shown on the bottom and latest motion at the top of the histograms. The dashed band in the background of the resting histograms is the normal range of regional fractional area change, which is shown for comparison with the individual patient’s data.

View larger version (94K): [in a new window]   Figure 4 Example of end-systolic color kinesis images obtained in a patient at rest (top), low dose (center) and peak dose of dobutamine infusion (bottom) in the four standard echocardiographic views (from left to right). At rest, the inferior segment in the short-axis view, basal septal segment in the apical four-chamber view and basal-posterior segment in the long-axis view were hypokinetic as reflected by the narrow color bands (top, open arrows). The inferior segment and basal-posterior segment subsequently improved with dobutamine, and basal septal segment did not change significantly. In contrast, anteroseptal and septal segments in the short-axis view, mid-septal and mid-inferior segments in the apical views, as well as mid- and basal anteroseptal segments in the long-axis view, became abnormal at peak dobutamine, as reflected by narrow or disrupted color bands (bottom, solid arrows). Coronary angiography in this patient revealed significant stenosis of both the right coronary and the left anterior descending coronary arteries.

View larger version (47K): [in a new window]   Figure 5 Stacked color histograms of regional fractional area change obtained from images in Figure 4. The normal range of regional fractional area change shown as a dashed band in the background of the resting histograms allowed objective identification of the regional wall motion abnormalities noted in this patient at rest (top, open arrows). The resting histograms, scaled down to 60% and shown as dotted areas in the background of histograms obtained with dobutamine, allow objective detection of stress-induced wall motion abnormalities (bottom, solid arrows) in the perfusion territory of the left anterior descending coronary artery.

View larger version (21K): [in a new window]   Figure 6 (Top) schematic distribution of segments according to their wall motion at rest and at peak dobutamine, as well as the type of response to dobutamine, according to the consensus interpretation of two experienced reviewers. (Bottom) Segments that showed ischemic response to dobutamine were classified by the inexperienced reviewers and by the analysis of color kinesis images. Open bars: normal wall motion; dotted bars: abnormal wall motion.

View larger version (22K): [in a new window]   Figure 7 Reproducibility of segmental analysis of color kinesis images obtained with peak dose of dobutamine infusion. Variability was calculated for each segment as absolute difference of repeated measurements in percent of their mean. Data are presented as mean of nine patients (dark bars) with the extreme values measured (light bars).