HOW DOES COMPUTER-ASSISTED DIGITAL WALL-MOTION ANALYSIS INFLUENCE OBSERVER AGREEMENT AND DIAGNOSTIC-ACCURACY DURING STRESS ECHOCARDIOGRAPHY

This study assessed interobserver and intraobserver variation and diag nostic accuracy during 25 dipyridamole stress echocardiography tests i nterpreted with different analysis systems: a) computer display of hig h frame rate digital cineloops (47 frames/s); b) computer display of l ower frame rate digital cineloops (24 frames/s); and c) videotape reco rdings. The majority of the patients (84%) had documented coronary art ery disease with baseline wall motion anormalities due to previous myo cardial infarctions and/or coronary bypass surgery, thus comprising a population with difficult interpretation of stress echocardiography. D iagnostic accuracy was assessed using coronary angiography as referenc e method. Interobserver and intraobserver agreement was highest when a nalysis was performed from computer-displayed cineloops, 96 and 92%, r espectively, compared to 84 and 80% respectively, using videotape reco rdings. Sensitivity for identification of coronary artery stenosis was similar using digital cineloops with high frame rate or videotape rec ordings (67% to 80% for both systems), and tended to be lower using ci neloops with lower frame rate for analysis (53%). Inter- and intraobse rver differences for wall motion score index were not significantly in fluenced by the analysis system. We conclude that computer assisted an alysis with high frame rate of the displayed cineloops provides optima l observer agreement and diagnostic accuracy in the same range as vide otape analysis in patients undergoing stress echocardiography.