Global longitudinal strain in heart transplantation recipients using different vendors: reliability and validity in a tertiary hospital in Colombia

Abstract

Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coe cient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and speci city of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p<0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Speci city of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.

Global longitudinal strain (GLS)

“…The team of Dr Oscar Mauricio Perez-Fernandez and Dr Frida Tatiana Manrique from the Cardiology Institute in Bogota, Columbia published a paper about the reliability and validity of the GLS in heart transplant patients in a tertiary hospital in Colombia [1]. They used the GLS software from two different vendors and found significant inter-vendor variability in the GLS.…”