Albunex improves agreement between experienced and less-experienced echocardiographers for the evaluation of left ventricular wall motion during bicycle stress echocardiography

Objective: To determine if contrast-enhanced imaging using Albunex® during bicycle stress echocardiography (BSE) improved the degree of agreement between experienced (EX) and less-experienced (LEX) echocardiographers for the evaluation of LV wall motion (LVWM). Methods: 125 patients underwent rest echocardiography followed by unenhanced and contrast enhanced BSE. Rest images were obtained in the 4 standard views. At peak exercise, Albunex® (0.3 mL/kg) was injected after acquisition of the unenhanced images, and contrast-enhanced imaging of the A4C and A2C views was repeated. Images were captured digitally, and 2 image sets (rest/stress unenhanced and rest/stress enhanced) were independently randomized for each patient between 5 EX/LEX reader pairs. Each reader provided a blinded assessment of LVWM for each segment using a graded scoring system. The rate of agreement, an exact match for the score of each LV wall segment, within each EX/LEX reader pair was measured. The intra-reader reproducibility for the rate of agreement, and the value of disagreement, the difference in # of evaluable LV wall segments, were also measured. Results: The use of Albunex® significantly improved the ability of the EX/LEX reader pairs to agree on the WM score for the identical evaluation of each LV wall segment (p = 0.05). The intra-reader reproducibility for the rate of agreement was statistically significant for all four reader/image combinations (p = 0.001). However, the value of disagreement was only significant for the LV segment scoring of the peak stress unenhanced images (p = 0.05 for EX; p = 0.02 for LEX). Conclusions: Albunex® contrast enhancement in BSE improves agreement between EX and LEX echocardiographers for the evaluation of LVWM. Albunex® also appears to aid LEX echocardiographers in their evaluation of LVWM. The significance of the intra-reader reproducibility for the rate of agreement emphasizes test validity. In conclusion, Albunex® contrast enhancement in BSE results in a more accurate evaluation of LVWM by EX and LEX echocardiographers.