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European Journal of Echocardiography 2006 7(2):122-133; doi:10.1016/j.euje.2005.04.003
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Copyright © 2005, The European Society of Cardiology

Computerized evaluation of echocardiographic stress tests in patients with poorly visualized endocardium using analysis of color-encoded contrast-enhanced images*

Victor Mor-Avia,*, Lissa Sugenga, Robert J. Weissb, Eran Toledoa, Lynn Weinerta, Tina Bouchardb, Kirk T. Spencera and Roberto M. Langa

aSection of Cardiology, Noninvasive Cardiac Imaging Laboratory, University of Chicago MC5084, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
bAndroscoggin Cardiology Associates, Auburn, Maine, USA

Received 26 January 2005; received in revised form 22 March 2005; accepted after revision 9 April 2005.

* Corresponding author. Tel.: +1 773 702 1842; fax: +1 773 702 1034. vmoravi{at}medicine.bsd.uchicago.edu


  Abstract

Aims We hypothesized that real-time color encoding of contrast-enhanced images would allow objective detection of stress-induced wall motion abnormalities (WMA).

Methods We studied 117 patients with poorly visualized endocardium undergoing dobutamine stress tests. Color-encoded images (Philips, color kinesis) were obtained at rest and peak stress in four standard views during i.v. infusion of Definity. Images were reviewed without color overlays by two expert readers, who graded regional wall motion as normal or abnormal. In 101/117 patients (86%), in whom contrast enhancement allowed endocardial tracking, regional fractional area changes were calculated from the color overlays, and thresholds for calling a stress-induced WMA were optimized in a randomly selected subgroup of 34 patients (ROC analysis) to achieve maximum agreement with expert grades. This computerized detection of stress-induced WMA was then tested prospectively in the remaining 67 patients, using the expert grades as a "gold standard".

Results 20/67 patients had resting WMA and 13/67 patients developed WMA at peak stress. The automated technique detected stress-induced WMA in at least one vascular territory with a sensitivity, specificity and accuracy of 0.80, 0.65 and 0.69, while the level of agreement between the two experts was 0.62, 0.91 and 0.85, respectively.

Conclusion Analysis of color-encoded, contrast-enhanced images allows objective, accurate, automated detection of stress-induced WMA in patients with poor acoustic windows.

Keywords: Ultrasound imaging; Stress testing; Contrast media; Ventricular function

* Support: Grant-in-Aid from the American Heart Association and a research grant from Bristol-Myers Squibb.


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