Author + information
- Received May 26, 2016
- Revision received June 23, 2016
- Accepted June 23, 2016
- Published online May 1, 2017.
- Tomoko Negishi, MDa,
- Kazuaki Negishi, MD, PhDa,
- Paaladinesh Thavendiranathan, MDb,
- Goo-Yeong Cho, MDc,
- Bogdan A. Popescu, MD, PhDd,
- Dragos Vinereanu, MDd,
- Koji Kurosawa, MDe,
- Martin Penicka, MD, PhDf,
- Thomas H. Marwick, MBBS, PhD, MPHa,g,∗ (, )
- SUCCOUR Investigators
- aMenzies Institute for Medical Research, Hobart, Tasmania, Australia
- bUniversity of Toronto, Toronto General Hospital, Peter Munk Cardiac Center, Toronto, Ontario, Canada
- cSeoul National University Bundang Hospital, Seongnam, Republic of Korea
- dUniversity of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- eGunma University, Maebashi, Japan
- fCardiovascular Center, OLV Clinic Aalst, Aalst, Belgium
- gBaker IDI Heart & Diabetes Institute, Melbourne, Australia
- ↵∗Address for correspondence:
Dr. Thomas H. Marwick, Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia.
Objectives This study sought to show the degree to which experience and training affect the precision and validity of global longitudinal strain (GLS) measurement and to evaluate the variability of strain measurement after feedback.
Background The application of GLS for the detection of subclinical dysfunction has been recommended in an expert consensus document and is being used with increasing frequency. The role of experience in the precision and validity of GLS measurement is unknown, as is the efficacy of training.
Methods Fifty-eight readers, divided into 4 groups on the basis of their experience with GLS, calculated GLS from speckle strain analysis of 9 cases with various degrees of image quality. Intraclass correlation coefficients (ICCs), mean difference, SD, and coefficient of variation (CV) were compared against the measurements of a reference group that had experience with >1,000 cases of strain measurement. Individualized feedback was distributed, and repeat measurements were performed by 40 readers. Comparisons with the baseline variation provided information about whether feedback was effective.
Results The ICC for GLS was significantly greater than that for ejection fraction regardless of image quality. Experience with strain measurement affected the concordance in strain values among the readers; the group with the highest level of experience showed significantly better ICC than those with no experience, although the ICC of the inexperienced readers was still very good (0.996 vs. 0.975; p = 0.0002). As experience increased, the mean difference, SD, and CV became significantly smaller. The CV of segmental strain analysis showed significant improvement after training, regardless of experience.
Conclusions The favorable interobserver agreement of GLS makes it more attractive than ejection fraction for follow-up of left ventricular function by multiple observers. Although experience is important, the precision of GLS was high for all groups. Training appears to be of most value for the assessment of segmental strain.
This study was supported in part by General Electric Medical Systems. Dr. Popescu has received research support and speaker honoraria from GE Healthcare. Dr. Marwick is the principal investigator of the SUCCOUR randomized trial, which is partially financially supported by GE Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Paul Grayburn, MD, served as the Guest Editor for this article.
- Received May 26, 2016.
- Revision received June 23, 2016.
- Accepted June 23, 2016.
- 2017 American College of Cardiology Foundation