Interpretation of stress echocardiography

Abstract

The greatest current limitation of stress echocardiography is subjectivity. While some variations in the style and emphasis of performing the two-dimensional echo acquisition require a learning curve for the technician performing the test, the individual interpreting the test also has a great requirement for expertise. The length and difficulty of this process is related to the experience of the echocardiographer, but even with accomplished echocardiographers, experience varies with respect to the duration of this learning period. Picano (1) reported that 100 supervised studies were required to bring the accuracy of “novices” experienced in echocardiography (but not stress echocardiography) to the level of “experts”, whose accuracy did not vary over time (Figure 2.1). Subsequent work by Varga et al (2) has shown that accuracy and concordance between observers can be increased (though perhaps not to optimal levels) by a two-day training course. These studies were performed using dipyridamole stress echocardiography, with interpretations from video tape. Our impression is that the total learning period may be abbreviated using exercise or dobutamine echocardiography, and digital image processing. One other consequence of the subjective approach to image interpretation id that pattern recognition skills attenuate when they are not used and limited data suggest that accuracy is related to reading volume.