Improved interpretation of dobutamine stress echocardiography following 4 months of systematic training in patients following acute myocardial infarction

OBJECTIVES: Interpretation of stress echocardiography is subjective, and highly dependent on the experience of the interpreter. We sought to evaluate whether a cardiologist without any previous experience in stress echocardiography could adequately learn the skills of interpreting dobutamine stress echocardiograms (DSE) in post-infarct patients, after a period of systematic training. METHODS: A trainee in cardiology blindly reported 51 consecutive DSEs from a database of post-infarction studies, after 2 and 4 months of systematic training. We compared his interpretation with that of an expert. RESULTS: Agreement between the trainee and the expert improved significantly from 2 to 4 months of training in the left anterior descending artery territory for the overall scan interpretation (from kappa = 0.58 to kappa = 0.73; p = 0.03), wall thickening assessment in individual segments (from kappa = 0.40 to kappa = 0.55; p < 0.01) and the diagnosis of viable myocardium (from kappa = 0.11 to kappa = 0.43; p = 0.01). Similar improvement was observed in left circumflex, but not in the right coronary artery territory. Agreement in identifying inducible ischaemia also remained poor. CONCLUSION: This study suggests that systematic training can significantly reduce interobserver variability in a short time frame (4 months) and may improve the interpretation of DSE by a trainee. But improvements in image quality and use of predefined reading criteria are necessary to improve interobserver agreement further in myocardial regions where conformity in dobutamine stress echocardiographic interpretation is low.