title: Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, The University of Chicago Medical Center, Illinois 60637, USA.
authors.forename: R
authors.initials: R
authors.lastname: Koch
authors.forename: R M
authors.initials: RM
authors.lastname: Lang
authors.forename: M J
authors.initials: MJ
authors.lastname: Garcia
authors.forename: L
authors.initials: L
authors.lastname: Weinert
authors.forename: J
authors.initials: J
authors.lastname: Bednarz
authors.forename: C
authors.initials: C
authors.lastname: Korcarz
authors.forename: B
authors.initials: B
authors.lastname: Coughlan
authors.forename: A
authors.initials: A
authors.lastname: Spiegel
authors.forename: E
authors.initials: E
authors.lastname: Kaji
authors.forename: K T
authors.initials: KT
authors.lastname: Spencer
authors.forename: V
authors.initials: V
authors.lastname: Mor-Avi
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging; D004280:Dobutamine; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine