title: The Five View Technique for Stress Echocardiography: A Description and Evaluation of Segmental Imaging and Reported Angiographic Data.
abstract: Stress echocardiography is an accurate means of evaluating ischemic heart disease with sensitivities and specificities equivalent to alternate modalities. The sensitivities to disease of vessels with posterior wall distribution are, however, significantly lower. Studies establishing these figures have used a 4 view digital imaging technique as standard. This study aimed to determine if the use of a 5 view template (4 views plus an apical 3 chamber (3ch) view) significantly improved stress echo results. One hundred consecutive stress echocardiograms using a 5 view format were analyzed by two independent observers. Nine thousand regional wall segments were graded quantitatively and qualitatively and comparisons were made between the 4 and 5 view techniques. Reported angiographic sensitivities of the two techniques were analyzed and compared to the segmental imaging data. The 5 view template was found to increase overall segmental imaging by 30% and imaging of lateral and posterior walls was increased by 50% while the additional poststress cycle was acquired in under 13 seconds. Five view studies reported increased mean sensitivities to left anterior descending coronary artery (LAD) disease of 29.7%, right coronary artery (RCA) disease of 25.7%, and circumflex coronary artery (Cx) disease of 51.6%. This study found that the 5 view technique significantly increased left ventricular segmental imaging, particularly of the posterior and lateral walls, and is associated with increased angiographically determined sensitivity, particularly for vessels with posterior wall distribution when compared to the 4 view technique.
authors.affiliation: Cardiac Ultrasound Department, Baringa Cardiology Centre, P.O. Box J241, Cofts Harbour 2450, Australia rap_echo@commat;midcoast.com.au
authors.forename: Robert A.
authors.initials: RA
authors.lastname: Phillips
authors.forename: Michelle R.
authors.initials: MR
authors.lastname: Meurs
authors.forename: Jonathan H.
authors.initials: JH
authors.lastname: Waites