Automated versus visual segmental scoring: are we ready to replace the art of regional wall motion assessment?

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.