title: Side-by-side viewing of anatomically aligned left ventricular segments in three-dimensional stress echocardiography.
abstract: 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.
authors.affiliation: Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Attila
authors.initials: A
authors.lastname: Nemes
authors.forename: Ka Yan Esther
authors.initials: KY
authors.lastname: Leung
authors.forename: Gerard
authors.initials: G
authors.lastname: van Burken
authors.forename: Marijn
authors.initials: M
authors.lastname: van Stralen
authors.forename: Johan G
authors.initials: JG
authors.lastname: Bosch
authors.forename: Osama I I
authors.initials: OI
authors.lastname: Soliman
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Krenning
authors.forename: Wim B
authors.initials: WB
authors.lastname: Vletter
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: ten Cate
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
mesh_terms: 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
chemical_list: D003287:Contrast Media