Color Kinesis During Contrast-Enhanced Dobutamine Stress Echocardiography. Feasibility and Applicability.

Abstract

Accurate interpretation of dobutamine stress echocardiography (DSE) needs expertise. Color kinesis (CK) allows objective assessment of wall motion (WM), and its feasibility and accuracy are enhanced under harmonic imaging with contrast agents. To explore its utility, CK was performed in 41 unselected patients during contrast-enhanced DSE. After bolus injection of Levovist, the CK image was acquired in the apical 4- and 2-chamber views at baseline and peak stress using the ultraharmonic mode. Quad screen format with second harmonic imaging after another injection of Levovist was also obtained as a reference. Regional WM (12 segments in the apical view) was independently assessed by both methods. Heart rate increased from 67 beats/min at baseline to 135 beats/min (88% of age predicted maximal heart rate) at peak stress. The CK image was successfully obtained in all patients at baseline and in 38/41 patients at peak stress. CK tracked endocardial motion accurately in 93% (456/492) of left ventricular segments at baseline and 87% (427/492) at peak stress. The concordance rate of normal and abnormal WM between the 2 methods was 86% (392/456, Kappa 0.61) at baseline and 85% (362/427, kappa 0.53) at peak stress. Among the 38 patients in whom both methods were completed, the standard quad screen display showed abnormal DSE results in 17 patients and 28/114 vascular territories. The sensitivity, specificity and diagnostic accuracy of CK for detecting abnormal findings were, respectively, 71% (12/17), 90% (19/21) and 82% (31/38) in patients and 57% (16/28), 97% (83/86) and 87% (99/114) in vascular territories. The application of CK was highly feasible during contrast-enhanced DSE and gave an objective assessment of WM. This method can be a valuable adjunct to the conventional interpretation of DSE.

Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography

“…CK has not been widely applied because of the requirement for proprietary software, labor intensive quantitation, and necessity for high-quality images. 91,92 The high sampling rates ($100 frames/sec) afforded by Doppler echocardiography enable assessment of both the timing and magnitude of contraction and relaxation. Both pulsed-wave (PW) and color Doppler techniques of tissue Doppler imaging (TDI) of myocardial segments have been investigated during dobutamine stress.…”

Quantitative Assessment of Left Ventricular Function During Contrast-Enhanced Dobutamine Stress Echocardiography Predicts Future Cardiac Events in Diabetic Patients

“…[19][20][21][22] Briefly, parasternal long-and short-axis views of the left ventricle (LV) were digitally acquired at baseline. After obtaining the apical 4-chamber view, 2 ml of the intravenous contrast agent (Levovist, Schering AG, Germany; 300 mg/ml) was injected, and CE images were digitally acquired in the apical 4-and 2-chamber views.…”

Dobutamine-Atropine Stress Echocardiography

“…Software for automatic tracing of the endocardial border of the contrast-enhanced LV cavity is available offering the opportunity for achievement of highly reproducible measurements of FAC at rest and during stress [104] . Furthermore, methods have been developed for the quantitative assessment of regional myocardial perfusion, enabling simultaneous evaluation of regional LV function and perfusion [105,106] .…”