title: Contrast agents provide a faster learning curve in dipyridamole stress echocardiography.
abstract: OBJECTIVE
  Interobserver variability is an important limitation of the stress echocardiography and depends on the echocardiographer training. Our aim was to evaluate if the use of contrast agents during dipyridamole stress echocardiography would improve the agreement between an experienced and a non-experienced observer in stress echo and therefore if contrast would affect the learning period of dypyridamole stress echo.
  
  
  RESULTS
  Two independent observers without knowledge of any patient data interpreted all stress studies. One observer was an experienced one and the other had experience in echocardiography but not in stress echo. Two observers analysed 87 non-selected and consecutive studies. Out of the 87 studies, 46 were performed without contrast administration, whereas i.v. contrast (2.5 g Levovist by two bolus at rest and at peak stress) was administered in 41. In all cases, second harmonic imaging and stress digitalisation pack was used. The agreement between observers showed a kappa index of 0.58 and 0.83 without and with contrast administration, respectively.
  
  
  CONCLUSIONS
  The use of contrast agents provides a better agreement in the evaluation of stress echo between an experienced and a non-experienced observer in stress echo. Adding routinely contrast agents could probably reduce the number of exams required for the necessary learning curve in stress echocardiography.
authors.affiliation: Department of Cardiology, Clinico San Carlos Hospital, Hospital Doce de Octubre, Madrid, Spain. jlzamorano@jet.es
authors.forename: Jose
authors.initials: J
authors.lastname: Zamorano
authors.forename: Violeta
authors.initials: V
authors.lastname: Sánchez
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: Carlos
authors.initials: C
authors.lastname: Almería
authors.forename: Jose
authors.initials: J
authors.lastname: Rodrigo
authors.forename: Viviana
authors.initials: V
authors.lastname: Serra
authors.forename: Luis
authors.initials: L
authors.lastname: Azcona
authors.forename: Adalia
authors.initials: A
authors.lastname: Aubele
authors.forename: Luis
authors.initials: L
authors.lastname: Mataix
authors.forename: Luis
authors.initials: L
authors.lastname: Sánchez-Harguindey
mesh_terms: D002983:Clinical Competence; D003287:Contrast Media; D004176:Dipyridamole; D004452:Echocardiography; D005080:Exercise Test; D006801:Humans; D015588:Observer Variation; D011134:Polysaccharides; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; D014665:Vasodilator Agents; C059891:SHU 508; D004176:Dipyridamole