The International Journal of Cardiac Imaging

, Volume 13, Issue 2, pp 105–114 | Cite as

How does computer-assisted digital wall motion analysis influence observer agreement and diagnostic accuracy during stress echocardiography?

  • Knut Bjørnstad
  • Svend Aakhus
  • Hans G. Torp


This study assessed interobserver and intraobserver variation and diagnostic accuracy during 25 dipyridamole stress echocardiography tests interpreted with different analysis systems: a) computer display of high frame rate digital cineloops (47 frames/s); b) computer display of lower frame rate digital cineloops (24 frames/s); and c) videotape recordings. The majority of the patients (84%) had documented coronary artery disease with baseline wall motion anormalities due to previous myocardial infarctions and/or coronary bypass surgery, thus comprising a population with difficult interpretation of stress echocardiography. Diagnostic accuracy was assessed using coronary angiography as reference method. Interobserver and intraobserver agreement was highest when analysis was performed from computer-displayed cineloops, 96 and 92%, respectively, compared to 84 and 80% respectively, using videotape recordings. Sensitivity for identification of coronary artery stenosis was similar using digital cineloops with high frame rate or videotape recordings (67% to 80% for both systems), and tended to be lower using cineloops with lower frame rate for analysis (53%). Inter- and intraobserver differences for wall motion score index were not significantly influenced by the analysis system. We conclude that computer assisted analysis with high frame rate of the displayed cineloops provides optimal observer agreement and diagnostic accuracy in the same range as videotape analysis in patients undergoing stress echocardiography.

digital echocardiography dipyridamole echocardiography stress echocardiography 


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  1. 1.
    Crouse L, Harbrecht J, Vacek J, Rosamond TL, Kramer PH. Exercise echocardiography as a screening test for coronary artery disease and correlation with coronary arteriography. Am J Cardiol 1991; 67: 1213-1218.CrossRefPubMedGoogle Scholar
  2. 2.
    Marwick TH, Nemec JJ, Pashkow FJ, Stewart WJ, Salcedo EE. Accuracy and limitations of exercise echocardiography in a routine clinical setting. J Am Coll Cardiol 1992; 19: 74-81.CrossRefPubMedGoogle Scholar
  3. 3.
    Armstrong WF. Stress echocardiography: diagnostic, prognostic and management tool for the 1990s. Echocardiography 1992; 9: 71-75.CrossRefPubMedGoogle Scholar
  4. 4.
    Visser CA, Res J, Jaarsma W. Utility of stress echocardiography for postinfarct prognosis. Echocardiography 1992; 9: 211-218.CrossRefPubMedGoogle Scholar
  5. 5.
    Krivokapich J, Child JS, Gerber RS, Lem V, Moser D. Prognostic usefulness of positive or negative exercise stress echocardiography for predicting coronary events in ensuing twelve months. Am J Cardiol 1993; 71: 646-651.CrossRefPubMedGoogle Scholar
  6. 6.
    Sawada SG, Ryan T, Conley MJ, Corya BC, Feigenbaum H, Armstrong WF. Prognostic value of a normal exercise echocardiogram. Am Heart J 1990; 120: 49-55.CrossRefPubMedGoogle Scholar
  7. 7.
    Roldan CA, Crawford MH. Stress echocardiography versus radionuclide stress techniques. Echocardiography 1992; 9: 199-209.CrossRefPubMedGoogle Scholar
  8. 8.
    Feigenbaum H. Evolution of stress echocardiography. Echocardiography 1992; 9: 73-75.CrossRefPubMedGoogle Scholar
  9. 9.
    Castini D, Gentile F, Ornaghi M, Montani E, Lippolis A, Mangiarotti E et al. Dobutamine echocardiography: usefulness of digital image processing. Eur Heart J 1995; 16: 1420-1424.CrossRefPubMedGoogle Scholar
  10. 10.
    Picano E, Lattanzi F, Masini M, Distante A, L'Abbate A. High dose dipyridamole-echocardiography test in effort angina pectoris. J Am Coll Cardiol 1986; 8: 848-854.CrossRefPubMedGoogle Scholar
  11. 11.
    Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358-367.CrossRefPubMedGoogle Scholar
  12. 12.
    Bjørnstad K, Aakhus S, Rokseth R, Bolz KD, Skjærpe T, Hatle L. Digital dipyridamole stress echocardiography in silent ischemia after coronary artery bypass grafting and/or after healing of acute myocardial infarction. Am J Cardiol 1993; 72: 640-646.CrossRefGoogle Scholar
  13. 13.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; I(8476): 307-310.CrossRefGoogle Scholar
  14. 14.
    Bland M. Clinical measurement. In: Bland M, ed. An introduction to medical statistics. Oxford, Oxford University Press, 1990: 283-285.Google Scholar
  15. 15.
    Picano E. Stress echocardiography: from pathophysiological toy to diagnostic tool. Circulation 1992; 85: 1604-1612.CrossRefPubMedGoogle Scholar
  16. 16.
    Zeiher AM, Wollschlaeger H, Bonzel T, Kasper W, Just H. Hierarchy of levels of ischemia-induced impairment in regional left ventricular systolic function in man. Circulation 1987; 76: 768-776.CrossRefPubMedGoogle Scholar
  17. 17.
    Kondo H, Masuyama T, Ishihara K, Mano T, Yamamoto K, Naito J et al. Digital subtraction high-frame-rate echocardiography in detecting delayed onset of regional left ventricular relaxation in ischemic heart disease. Circulation 1995; 91: 304-312.CrossRefPubMedGoogle Scholar
  18. 18.
    Torp HG, Dørum S, Holm E, Steen E, Kristoffersen K, Berg KA et al. Real time three dimensional echocardiography for assessment of valvular function. Abstracts of 11th symposium on echocardiology: Rotterdam 1995: 141.Google Scholar
  19. 19.
    Oberman A, Fan P, Nanda N, Lee JY, Huster WJ, Sulentic JA et al. Reproducibility of two-dimensional exercise echocardiography. J Am Coll Cardiol 1989; 14: 923-928.CrossRefPubMedGoogle Scholar
  20. 20.
    Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A. Stress echocardiography and the human factor: the importance of being expert. J Am Coll Cardiol 1991; 17: 666-669.CrossRefPubMedGoogle Scholar
  21. 21.
    Gould KL. Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. Am J Cardiol 1978; 41: 267-278.CrossRefPubMedGoogle Scholar
  22. 22.
    Aakhus S, Bjørnstad K, Hatle LK. Noninvasive study of left ventricular function and systemic haemodynamics during dipyridamole echocardiography stress test. Clin Physiol 1994; 14: 581-594.CrossRefPubMedGoogle Scholar
  23. 23.
    Bjørnstad K, Aakhus S, Hatle LK. Comparison of digital dipyridamole stress echocardiography and upright bicycle stress echocardiography for identification of coronary artery stenosis. Cardiology 1995; 86: 514-520.CrossRefPubMedGoogle Scholar
  24. 24.
    Bjørnstad K, Al Amri M, Lingamanaicker J, Oqaili I, Hatle L. Interobserver variation for interpretation of left ventricular wall motion at baseline and during low and high dose dobutamine stress echocardiography in patients with high prevalence of baseline wall motion abnormalities. J Am Soc Echocardiogr 1996; 9: 320-328.CrossRefPubMedGoogle Scholar
  25. 25.
    Armstrong WF, O'Donnell J, Ryan T, Feigenbaum H. Effect of prior myocardial infarction and extent and location of coronary disease on accuracy of exercise echocardiography. J Am Coll Cardiol 1987; 10: 531-538.CrossRefPubMedGoogle Scholar
  26. 26.
    Horowitz RS, Morganroth J. Immediate detection of early high-risk patients with acute myocardial infarction using two-dimensional echocardiographic evaluation of left ventricular regional wall motion abnormalities. Am Heart J 1982; 103: 814-822CrossRefPubMedGoogle Scholar
  27. 27.
    Nishimura RA, Reeder GS, Miller FA, Ilstrup DM, Shub C, Seward JB et al. Prognostic value of predischarge 2-dimensional echocardiogram after acute myocardial infarction. Am J Cardiol 1984; 53: 429-432.CrossRefPubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Knut Bjørnstad
    • 1
  • Svend Aakhus
    • 1
  • Hans G. Torp
    • 2
  1. 1.Department of MedicineSection of CardiologyNorway
  2. 2.Department of Physiology and Biomedical EngineeringUniversity Hospital of TrondheimTrondheimNorway

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