Reproducibility and experience dependence of echocardiographic indices of left ventricular function: Side‐by‐side comparison of global longitudinal strain and ejection fraction

Abstract

Background Although left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) are recommended by the current echocardiographic chamber quantification guidelines, these measurements are not performed routinely. Because EF measurements rely on manual tracing of LV boundaries, and are subject to inter‐reader variability and experience dependence, we hypothesized that semiautomated GLS measurements using speckle tracking would be more reproducible and less experience‐dependent. Methods Images from 30 patients were analyzed to obtain biplane EF using manual tracing. GLS was measured in three long‐axis views using EchoInsight software (Epsilon Imaging) that automatically detects LV endocardial boundary, which is edited manually as necessary and is then automatically tracked throughout the cardiac cycle. All measurements were performed by an expert echocardiographer and three first‐year cardiology fellows. Results Semiautomated GLS analysis showed excellent correlation (r=.98) and small bias (−1.0±13% of measured value) between the experienced and less experienced readers, superior to EF (r=.91, bias 7.3±16%). Also, in repeated measurements, GLS showed higher intra‐class correlation (ICC=.98) than EF (ICC=.89). Additionally, GLS analysis required ~1 minute per patient, while biplane EF measurements took twice as long. Conclusions Semiautomated GLS measurements are fast, less experience‐dependent, and more reproducible than conventional EF measurements. This is probably because, irrespective of experience, the readers' choice of boundary position varies less when asked to refine the automated detection than to draw borders without initial clues. This technique may facilitate the workflow of a busy laboratory and make a step forward toward incorporating quantitative analysis into everyday echocardiography practice.

Longitudinal strain measured by two‐dimensional speckle tracking echocardiography to evaluate left ventricular function in patients with myocardial bridging of the left anterior descending coronary artery

“…Abnormal coronary artery hemodynamics may be the primary cause of myocardial ischemia . Some findings may impute the view that LVEF represents left ventricular global systolic function; the sensitivity and specificity of left ventricular regional systolic function for myocardial ischemia are lower than that of LS . Stokke et al reported a study showing strain imaging probably better reflects systolic function in patients with a preserved estimated LVEF.…”

“…the sensitivity and specificity of left ventricular regional systolic function for myocardial ischemia are lower than that of LS. 35,36 Stokke et al 37 reported a study showing strain imaging probably better reflects systolic function in patients with a preserved estimated LVEF. Therefore, the LAD-TPLS and LV-GPLS were decreased, while LVEF was normal.…”

Left ventricular strain and arterial hypertension: Is longitudinal strain ready for primetime?

“…We are not even close to make this kind of consensus for LV circumferential and radial strain. However, one thing is certain, when LV longitudinal strain assessment is made using the same vendor or software from the time of diagnosis through the whole follow‐up, one could be certain that evaluation of strain is much more reproducible than calculation of LV ejection fraction over this period . According to the physiological mechanics of LV systolic function, longitudinal dysfunction may serve as a marker at an early stage of myocardial damage, whereas the change in LV circumferential strain appears to maintain LVEF as a mechanistic compensation.…”

Added value of speckle tracking in the evaluation of cardiac function in patients with sickle cell disease

“…It has been proposed that the left ventricle global longitudinal strain (LV‐GLS) could be a useful tool for the detection of early systolic dysfunction in patients under cardiotoxic chemotherapy (Thavendiranathan et al , ). Moreover, the high reproducibility of the LV‐GLS represents an advantage over the left ventricle ejection fraction (LVEF) (King et al , ; Medvedofsky et al , ). Compared to the LVEF, the LV‐GLS is less affected by changes in loading conditions, which makes it a potentially useful tool in patients with sickle cell disease (SCD), due to the chronic overload associated with SCD.…”