title: Color encoding of endocardial motion improves the interpretation of contrast-enhanced echocardiographic stress tests by less-experienced readers.
abstract: BACKGROUND
  We hypothesized that color encoding of endocardial motion could aid less-experienced readers in detection of wall-motion abnormalities at rest and stress in patients with poor acoustic windows.
  
  
  METHODS
  Color-encoded images (color kinesis) were obtained at rest and peak dobutamine stress in 4 standard views during intravenous infusion of contrast agent in 117 patients with poorly visualized endocardium. In 101 of 117 patients (86%), in whom contrast enhancement allowed endocardial tracking, images were reviewed by two expert readers without color overlays. Each reader graded regional wall motion as normal, abnormal, or uninterpretable, and their consensus grades served as a gold standard. The same images were then reviewed and graded with and without color overlays by 3 cardiology fellows. The accuracy of the interpretation was calculated against the gold standard separately for the 3 vascular territories (left anterior descending, left circumflex, and right coronary arteries) and averaged for the 3 fellows.
  
  
  RESULTS
  With the addition of color encoding: (1) the number of uninterpretable segments decreased by 55% at rest and 61% at peak stress; and (2) all 3 fellows reached higher levels of accuracy in all 3 vascular territories both at rest (6%-82% average) and at stress (73%-80%).
  
  
  CONCLUSIONS
  The addition of color encoding of wall motion to contrast-enhanced images obtained in patients with poor acoustic windows during stress tests improves the interpretation of regional left ventricular function by less-experienced readers.
authors.affiliation: Noninvasive Cardiac Imaging Laboratory, University of Chicago, Chicago, Illinois, USA. vmoravi@medicine.bsd.uchicago.edu
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Jacobs
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weiss
authors.forename: Lissa
authors.initials: L
authors.lastname: Sugeng
authors.forename: Lynn
authors.initials: L
authors.lastname: Weinert
authors.forename: Tina
authors.initials: T
authors.lastname: Bouchard
authors.forename: Kirk T
authors.initials: KT
authors.lastname: Spencer
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D004699:Endocardium / Q000000981:diagnostic imaging* / Q000187:drug effects; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D016247:Information Storage and Retrieval / Q000379:methods; D009068:Movement; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014584:User-Computer Interface; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D014665:Vasodilator Agents; D004280:Dobutamine