Effect of tissue Doppler on the accuracy of novice and expert interpretersof Dobutamine echocardiography

The subjective interpretation of dobutamine echocardiography (DBE) makes th e accuracy of this technique dependent on the experience of the observer, a nd also poses problems of concordance between observers. Myocardial tissue Doppler velocity (MDV) may offer a quantitative technique for identificatio n of coronary artery disease, but it is unclear whether this parameter coul d improve the results of less expert readers and in segments with low inter observer concordance. The aim of this study was to find whether MDV improve d the accuracy of wall motion scoring in novice readers, experienced echoca rdiographers, and experts in stress echocardiography, and to identify the o ptimal means of integrating these tissue Doppler data in 77 patients who un derwent DBE and angiography. New or worsening abnormalities were identified as ischemia and abnormalities seen at rest as scarring. Segmental MDV was measured independently and previously derived cutoffs were applied to categ orize segments as normal or ab normal. Five strategies were used to combine MDV and wall motion score, and the results of each reader using each strat egy were compared with quantitative coronary angiography. The accuracy of w all motion scoring by novice (68 +/- 3%) and experienced echocardiographers (71 +/- 3%) was less than experts in stress echocardiography (88 +/- 3%, p < 0.001). Various strategies for integration with MDV significantly improv ed the accuracy of wall motion scoring by novices from 75 +/- 2% to 77 +/- 5% (p < 0.01). Among the experienced group, accuracy improved from 74 +/- 2 % to 77 +/- 5% (p < 0.05), but in the experts, no improvement was seen from their baseline accuracy. Integration with MDV also improved discordance re lated to the basal segments. Thus, use of MDV in all segments or MDV in all segments with wall motion scoring in the apex offers an improvement in sen sitivity and accuracy with minimal compromise in specificity. (C) 2001 by E xcerpta Medica, Inc.