Automated Versus Visual Segmental Scoring

Abstract

Echocardiography is the most widely used noninvasive test for assessing the structure and function of the heart, accounting for 14% of overall Medicare expenditures for imaging in 2007.1 Despite the availability of a variety of validated quantitative methods for assessing chamber size and cardiac function, many elements of echocardiographic interpretation remain qualitative rather than quantitative. This is particularly true of the assessment of regional wall motion. Notwithstanding progress in the field of myocardial perfusion echocardiography2 and earlier efforts to quantitate regional function with acoustic quantitation3 and Doppler tissue imaging-based methods,4 echocardiographic assessment of regional wall motion remains the principal method by which echocardiographers make the diagnosis of coronary disease. Moreover, the ability to visually identify stress-induced regional wall motion abnormalities is the foundation for stress echocardiography. Article see p 47 The ability to reproducibly and reliably detect regional wall motion abnormalities is an essential skill for any physician interpreting echocardiograms and conceded to be one of the most difficult skills to acquire.5 Consequently, an automated quantitative approach to assessing regional function would be invaluable as a tool for the interpretation of echocardiograms for teaching and research and could prove useful in training echocardiographers. The study of Liel Cohen6 in this issue of Circulation: Cardiovascular Imaging proposes just such a tool. In their article, the authors report their evaluation of a semiautomated method of measuring regional longitudinal strain to develop segmental scores, classifying segments as normal, hypokinetic, or akinetic/dyskinetic/aneurysmal. As the authors note, strain analysis based on speckle tracking as opposed to angle-dependent Doppler tissue imaging methods is appealing because it avoids translation artifact and angle dependence. Twelve expert echocardiographers of the Israeli Echocardiography Research Group at 9 major Israeli cardiology centers used this approach as well as qualitative visual segmental scoring in 15 patients …