Comparison of strain parameters in dyssynchronous heart failure between speckle tracking echocardiography vendor systems

Abstract

BackgroundAlthough mechanical dyssynchrony parameters derived by speckle tracking echocardiography (STE) may predict response to cardiac resynchronization therapy (CRT), comparability of parameters derived with different STE vendors is unknown.MethodsIn the MARC study, echocardiographic images of heart failure patients obtained before CRT implantation were prospectively analysed with vendor specific STE software (GE EchoPac and Philips QLAB) and vendor-independent software (TomTec 2DCPA). Response was defined as change in left ventricular (LV) end-systolic volume between examination before and six-months after CRT implantation. Basic longitudinal strain and mechanical dyssynchrony parameters (septal to lateral wall delay (SL-delay), septal systolic rebound stretch (SRSsept), and systolic stretch index (SSI)) were obtained from either separate septal and lateral walls, or total LV apical four chamber. Septal strain patterns were categorized in three types. The coefficient of variation and intra-class correlation coefficient (ICC) were analysed. Dyssynchrony parameters were associated with CRT response using univariate regression analysis and C-statistics.ResultsTwo-hundred eleven patients were analysed. GE-cohort (n = 123): age 68 years (interquartile range (IQR): 61–73), 67% male, QRS-duration 177 ms (IQR: 160–192), LV ejection fraction: 26 ± 7%. Philips-cohort (n = 88): age 67 years (IQR: 59–74), 60% male, QRS-duration: 179 ms (IQR: 166–193), LV ejection fraction: 27 ± 8. LV derived peak strain was comparable in the GE- (GE: -7.3 ± 3.1%, TomTec: −6.4 ± 2.8%, ICC: 0.723) and Philips-cohort (Philips: −7.7 ± 2.7%, TomTec: −7.7 ± 3.3%, ICC: 0.749). SL-delay showed low ICC values (GE vs. TomTec: 0.078 and Philips vs. TomTec: 0.025). ICC’s of SRSsept and SSI were higher but only weak (GE vs. TomTec: SRSsept: 0.470, SSI: 0.467) (Philips vs. QLAB: SRSsept: 0.419, SSI: 0.421). Comparability of septal strain patterns was low (Cohen’s kappa, GE vs. TomTec: 0.221 and Philips vs. TomTec: 0.279). Septal strain patterns, SRSsept and SSI were associated with changes in LV end-systolic volume for all vendors. SRSsept and SSI had relative varying C-statistic values (range: 0.530–0.705) and different cut-off values between vendors.ConclusionsAlthough global longitudinal strain analysis showed fair comparability, assessment of dyssynchrony parameters was vendor specific and not applicable outside the context of the implemented platform. While the standardization taskforce took an important step for global peak strain, further standardization of STE is still warranted.Electronic supplementary materialThe online version of this article (10.1186/s12947-017-0116-5) contains supplementary material, which is available to authorized users.

Speckle tracking echocardiographically-based analysis of ventricular strain in children: an intervendor comparison

“…Overall, we found very wide variation in measures between all the software packages and settings for longitudinal and circumferential TTPSD. Although TTPSD may be reproducible amongst the same vendors in adults [4,22] and children [3], our data suggest avoidance of interchanging the TTPSD measures between studies using different vendor software packages and settings [3].…”

“…Since ventricular synchrony measures are associated with life-threatening arrhythmias, heart failure, and mortality in pediatric populations [7,8], understanding the variability between vendors might allow the generalizability of these findings across echocardiography laboratories. Van Everdingen et al demonstrated minimal differences in longitudinal TTPSD with adults (patients had a range of structurally normal hearts and varying degrees of cardiac function and arrhythmias) between QLAB (10.0) and TomTec (1.2.1.2) [4]. Values were lower (more synchronous) in QLAB compared to the TomTec.…”

“…Left ventricular (LV) strain by two-dimensional (2D) speckle-tracking echocardiography has been shown to be a reliable and clinically important method of quantitatively characterizing cardiac function in children [1][2][3]. In addition, LV strain is correlated with synchrony [3][4][5][6] and their interdependence plays an important role in managing patients with both congenital and acquired heart disease [7][8][9][10][11][12]. Strain and synchrony can be calculated with the use of a variety of analysis packages, some of which are vendor-specific, while others are vendorindependent [13].…”

“…Recent studies in adults [14] and children [15,16], as well as an international task force for deformation imaging, have investigated the variations in reported values of strain from different packages [10,13]. A paucity of evidence on inter-vendor synchrony differences currently exists, with only a single study published in adults, and none in children [4]. We hypothesized that different modern analysis packages may produce different results in both strain and synchrony values in children, independent of acquisition.…”

Changes in mechanical dyssynchrony in severe aortic stenosis patients undergoing transcatheter aortic valve replacement

“…There is significant variation in technology between echocardiography system vendors. 30 In addition, our current study was performed using the Philips IE33 platform in which segmental strain reproducibility is considered suboptimal.…”