Author + information
- Received October 21, 2016
- Revision received January 24, 2017
- Accepted January 26, 2017
- Published online January 1, 2018.
- Oana Mirea, MD, PhDa,
- Efstathios D. Pagourelias, MD, PhDa,
- Jurgen Duchenne, MSca,
- Jan Bogaert, MD, PhDb,
- James D. Thomas, MDc,
- Luigi P. Badano, MD, PhDd,
- Jens-Uwe Voigt, MD, PhDa,∗ (, )
- on behalf of the EACVI-ASE-Industry Standardization Task Force
- aDepartment of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
- bDepartment of Radiology, University Hospital Leuven, Leuven, Belgium
- cBluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
- dCardiac, Thoracic and Vascular Sciences, University Padua, Padua, Italy
- ↵∗Address for correspondence:
Prof. Dr. Jens-Uwe Voigt, Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Objectives In this study, we compared left ventricular (LV) segmental strain measurements obtained with different ultrasound machines and post-processing software packages.
Background Global longitudinal strain (GLS) has proven to be a reproducible and valuable tool in clinical practice. Data about the reproducibility and intervendor differences of segmental strain measurements, however, are missing.
Methods We included 63 volunteers with cardiac magnetic resonance–proven infarct scar with segmental LV function ranging from normal to severely impaired. Each subject was examined within 2 h by a single expert sonographer with machines from multiple vendors. All 3 apical views were acquired twice to determine the test-retest and the intervendor variability. Segmental longitudinal peak systolic, end-systolic, and post-systolic strain were measured using 7 vendor-specific systems (Hitachi, Tokyo, Japan; Esaote, Florence, Italy; GE Vingmed Ultrasound, Horten, Norway; Philips, Andover, Massachusetts; Samsung, Seoul, South Korea; Siemens, Mountain View, California; and Toshiba, Otawara, Japan) and 2 independent software packages (Epsilon, Ann Arbor, Michigan; and TOMTEC, Unterschleissheim, Germany) and compared among vendors.
Results Image quality and tracking feasibility differed among vendors (analysis of variance, p < 0.05). The absolute test-retest difference ranged from 2.5% to 4.9% for peak systolic, 2.6% to 5.0% for end-systolic, and 2.5% to 5.0% for post-systolic strain. The average segmental strain values varied significantly between vendors (up to 4.5%). Segmental strain parameters from each vendor correlated well with the mean of all vendors (r2 range 0.58 to 0.81) but showed very different ranges of values. Bias and limits of agreement were up to −4.6 ± 7.5%.
Conclusions In contrast to GLS, LV segmental longitudinal strain measurements have a higher variability on top of the known intervendor bias. The fidelity of different software to follow segmental function varies considerably. We conclude that single segmental strain values should be used with caution in the clinic. Segmental strain pattern analysis might be a more robust alternative.
Dr. Mirea is permanently affiliated to the Department of Cardiology, University Hospital of Craiova, Romania. This study was supported by a dedicated grant from the American Society of Echocardiography. Dr. Mirea has received a research grant from the European Association of Cardiovascular Imaging. Dr. Pagourelias holds a research grant from the European Association of Cardiovascular Imaging. Dr. Thomas has received honoraria and consulting fees from Edwards Lifesciences, Abbott, and GE. Dr. Voigt holds a personal research mandate from the Flemish Research Foundation; and has received a research grant from the University Hospital Gasthuisberg. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 21, 2016.
- Revision received January 24, 2017.
- Accepted January 26, 2017.
- 2018 American College of Cardiology Foundation