Abstract
Over the past decade, exercise and pharmacological stress echocardiography techniques have emerged as mainstream modalities for the diagnosis of coronary artery disease. While the overall diagnostic accuracy of echocardiography-based stress techniques is high [1–8], these methods are inherently limited by the subjective nature of image interpretation as well as interobserver variability. In fact, results of a large, multicenter study demonstrated only 73% agreement in dobutamine echocardiographic interpretations between institutions, a finding that was even more pronounced in patients with poor image quality where interinstitutional agreement was only 43% [9]. While uniform criteria for test positivity enhances the diagnostic value of echocardiographic stress techniques by decreasing interobserver variability, the cornerstone of stress echocardiography remains visual interpretation of wall motion [10].
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