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

OBJECTIVES To test the feasibility of objective and automated evaluation of echocardiographic stress tests, we studied the ability of segmental analys is of color kinesis (CK) images to detect dobutamine-induced wall motion ab normalities and compared this technique with inexperienced reviewers of con ventional 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 undergoin g clinical dobutamine stress studies and were analyzed using custom softwar e to calculate regional fractional area change in 22 segments in four stand ard views. Each patient's data obtained at rest was used as a control for a utomated detection of dobutamine-induced wall motion abnormalities. Indepen dently, studies were reviewed without CK overlays by two inexperienced read ers who classified each segment's response to dobutamine. A consensus readi ng of two experienced reviewers was used as the gold standard for compariso ns. 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 4 3 of 1958 segments in 23 of 89 patients. Automated detection of stress-indu ced wall motion abnormalities correlated more closely with the standard tec hnique than the inexperienced reviewers (sensitivity 0.76 vs. 0.55, specifi city 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 differentiate d between normal and abnormal wall motion more accurately than expert reade rs of gray-scale images (accuracy of 0.93 vs. 0.82). CONCLUSIONS Analysis of CK images allows fast, objective and automated eval uation of regional wall motion, sensitive enough for clinical dobutamine st ress data and more accurate than inexperienced readers. This method may res ult in a valuable adjunct to conventional visual interpretation of dobutami ne stress echocardiography. (C) 1999 by the American College of Cardiology.