title: [Evaluation of echocardiographic left ventricular wall motion analysis supported by internet picture viewing system].
abstract: BACKGROUND
  Assessment of deterioration of regional wall motion by echocardiography is not only subjective but also features difficulties with interobserver agreement. Progress in digital communication technology has made it possible to send video images from a distant location via the Internet.
  
  
  OBJECTIVE
  The possibility of evaluating left ventricular wall motion using video images sent via the Internet to distant institutions was evaluated.
  
  
  METHODS
  Twenty-two subjects were randomly selected. Four sets of video images (parasternal long-axis view, parasternal short-axis view, apical four-chamber view, and apical two-chamber view) were taken for one cardiac cycle. The images were sent via the Internet to two institutions (observer C in facility A and observers D and E in facility B) for evaluation. Great care was taken to prevent disclosure of patient information to these observers. Parasternal long-axis images were divided into four segments, and the parasternal short-axis view, apical four-chamber view, and apical two-chamber view were divided into six segments. One of the following assessments, normokinesis, hypokinesis, akinesis, or dyskinesis, was assigned to each segment. The interobserver rates of agreement in judgments between observers C and D, observers C and E, and intraobserver agreement rate (for observer D) were calculated.
  
  
  RESULTS
  The rate of interobserver agreement was 85.7% (394/460 segments; Kappa = 0.65) between observers C and D, 76.7% (353/460 segments; Kappa = 0.39) between observers D and E, and 76.3% (351/460 segments; Kappa = 0.36)between observers C and E, and intraobserver agreement was 94.3% (434/460; Kappa = 0.86). Segments of difference judgments between observers C and D were normokinesis-hypokinesis; 62.1%, hypokinesis-akinesis; 33.3%, akinesis-dyskinesis; 3.0%, and normokinesis-akinesis; 1.5%.
  
  
  CONCLUSIONS
  Wall motion can be evaluated at remote institutions via the Internet.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kinki University School of Medicine, Osaka. yuhirano-circ@umin.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirano
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Ikuta
authors.forename: Manabu
authors.initials: M
authors.lastname: Nakano
authors.forename: Seita
authors.initials: S
authors.lastname: Akiyama
authors.forename: Hajime
authors.initials: H
authors.lastname: Nakamura
authors.forename: Masataka
authors.initials: M
authors.lastname: Nasu
authors.forename: Futoshi
authors.initials: F
authors.lastname: Saito
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakagawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Matsuzaki
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D006801:Humans; D020407:Internet; D008875:Middle Aged; D011897:Random Allocation; D017216:Telemedicine / Q000379:methods*; D016277:Ventricular Function, Left