Color kinesis during contrast-enhanced dobutamine stress echocardiography: feasibility and applicability

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.