Side-by-side viewing of anatomically aligned left ventricular segments in three-dimensional stress echocardiography.
BACKGROUND
Dobutamine stress echocardiography (DSE) suffers from high interobserver and inter-institution variability in the diagnosis of myocardial ischemia. Therefore, we developed a three-dimensional (3D) analysis tool that makes it possible to anatomically align 3D rest and stress data systematically, to generate optimal, nonforeshortened standard anatomical cross sections and to analyse the images synchronized and side-by-side.


OBJECTIVE
To investigate whether this 3D analysis tool could improve interobserver agreement on myocardial ischemia during 3D DSE.


METHODS
The study comprised 34 consecutive patients with stable chest pain who underwent both noncontrast and contrast 3D DSE. Two observers scored segmental wall motion using a conventional analysis and the novel analysis with the new 3D tool.


RESULTS
The two observers agreed on the presence or absence of myocardial ischemia in 81 of 102 coronary territories (agreement 79%, kappa (kappa) 0.28) during noncontrast 3D imaging and 92 of 102 coronary territories (agreement 90%, kappa 0.65) during contrast-enhanced 3D imaging. With the new 3D analysis software these numbers improved to 98 of 102 coronary territories (agreement 96%, kappa 0.69) during noncontrast 3D imaging and 98 of 102 coronary territories (agreement 96%, kappa 0.82) during contrast-enhanced 3D imaging.


CONCLUSIONS
The use of a 3D DSE analysis tool improves interobserver agreement for myocardial ischemia both for noncontrast and contrast images.
Nemes
Attila
A
Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands.
Leung
Ka Yan Esther
KY
van Burken
Gerard
G
van Stralen
Marijn
M
Bosch
Johan G
JG
Soliman
Osama I I
OI
Krenning
Boudewijn J
BJ
Vletter
Wim B
WB
ten Cate
Folkert J
FJ
Geleijnse
Marcel L
ML
D003287:Contrast Media; D025401:Echocardiography, Stress / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015588:Observer Variation; D012189:Retrospective Studies
D003287:Contrast Media