Reproducibility of global left atrial strain and strain rate between novice and expert using multi-vendor analysis software

Abstract

Left atrial (LA) strain is an emerging technique with potential applications including arrhythmia prediction in atrial fibrillation and early identification of atrial dysfunction. The aim of this study was to evaluate reproducibility of LA strain and strain rate (SR) using multi-vendor analysis software between novice and expert. For LA strain to be a reliable tool, the technique must be reproducible by observers with variable experience. Use of multi-vendor analysis software allows serial strain assessment when echocardiographic images are acquired using different vendors. Fifty subjects underwent 2D-Speckle tracking echocardiographic (STE) derived LA strain and SR analysis measured from apical four and two-chamber views. Three strain parameters of LA function were assessed: reservoir (S-LAs, SR-LAs), contractile (S-LAa, SR-LAa) and conduit (S-LAs-S-LAa, SR-LAe). Strain analyses were performed by 2 independent, blinded novice and expert observers using multi-vendor analysis software. Intraobserver and interobserver analyses were performed using intra class correlation coefficients (ICC) and Bland-Altman analysis. LA strain and SR measured by novice observer demonstrated excellent intraobserver reproducibility (ICC for all strain and SR values> 0.88). There was good interobserver agreement of LA strain values between novice and expert (S-LAs:ICC 0.81, S-LAe:ICC 0.82, S-LAa:ICC 0.74). SR values also demonstrated good interobserver agreement (SR-LAs:ICC 0.83, SR-LAe:ICC 0.79, SR-LAa:ICC 0.86). Of all parameters, SR-LAa had the best interobserver and intraobserver agreement (ICC 0.86, 0.96). Global LA strain and SR values were highly reproducible by novice strain reader using multi-vendor analysis software. Interobserver reproducibility between novice and experts were good and acceptable within limits of agreement.

Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction

“…We had assessed LA strain and strain rate in a subgroup of the population and LASRa proved to have an inter-class correlation (ICC) of 0.89, p < 0.001. [ 11 ] Other researchers found a similar ICC for LA strain and strain rate inter-observer reproducibility (ICC = 0.74–0.86, p < 0.01) [ 19 ] as well as LV strain with ICC > 0.89 [ 20 ].…”

Assessment of Left Atrial Function in Patients with Paroxysmal, Persistent, and Permanent Atrial Fibrillation Using Two-Dimensional Strain.

“…Global longitudinal strain, evaluated by STE, is a well-validated parameter used to quantify LV longitudinal function [5] in sinus rhythm and in AF [4,[6][7] . Recently, this technique has also been used in the assessment of regional and global left atrial (LA) function [8][9][10] with good reproducibility [11] . The latest European Association of Cardiovascular Imaging (EACVI)/ European Heart Rhythm Association (EHRA) Expert Consensus Document considers LA strain as a promising method which can be used for indirect measurement of atrial function in AF [6] .…”

Identifying Adverse Remodeling in Hypertrophic Cardiomyopathy Phenotypes Role of Left Atrial Parameters

“…Measuring global LA strain and maximum LA volume is easier, reproducible, and has shown less interobserver variability than phasic volumes and strain in various studies involving normal and diseased subjects [14]. Based on this hypothesis, these parameters could be easily obtained and correlated in a large HCMP population with minimal interobserver variability.…”