Variability in the Assessment of Myocardial Strain Patterns: Implications for Adequate Interpretation

Abstract

Variability in global and regional peak strain has been thoroughly studied, but not the variability in the spatiotemporal myocardial strain patterns. This study reports on such variability and its implications for adequate disease interpretation. Forty in-training operators were distributed on 20 workstations, and analyzed six cases with representative deformation patterns with commercial speckle-tracking. Inter-operator differences were quantified through the variability in myocardial delineations, spatiotemporal longitudinal strain patterns, and peak longitudinal strain. Intra-operator differences were assessed similarly using 10 repeated measurements from a single clinician expert. Delineations varied mainly along the lateral wall and at the valve level. Peak longitudinal strain variability was low to moderate. The spatiotemporal strain patterns were consistent despite high variability at the apex and near the valve. The results indicate that relevant pattern assessment is possible despite heterogeneous experience with speckle-tracking, and that careful interpretation of pattern abnormalities should be recommended before a more systematic quantitative analysis.

Etiology-Discriminative Multimodal Imaging of Left Ventricular Hypertrophy and Synchrotron-Based Assessment of Microstructural Tissue Remodeling

“…Nonetheless, no causation can be claimed based on these initial results. The results motivate larger patient cohorts to enable statistical analysis/group comparison, as well as the assessment of reproducibility of deformation patterns ( 44 ).…”

“…Regional longitudinal strain is still burdened by reproducibility and inter-vendor variability (41)(42)(43). Nevertheless, regional spatiotemporal strain patterns contain important diagnostic information (3,41), and remain consistent despite underlying variability in inter-observer segmentations and regional peak strain values (44). The results of this pilot study are hypothesis-generating, suggesting non-invasive deformation phenotypes are associated with etiology-related myocyte and connective tissue matrix 3D disorganization, thus inferring the potential clinical value of deformation patterns in everyday clinical analysis and phenotyping LV hypertrophy.…”

Quality Assurance of Segmental Strain Values Provided by Commercial 2-D Speckle Tracking Echocardiography Using in Silico Models: A Report from the EACVI-ASE Strain Standardization Task Force

“…Although the accuracy of segmental strain values were tested in this study, important information may lie in the temporal characteristics of the segmental strain curves either by visual readings (Menet, et al 2017) or via pattern recognition (Tabassian, et al 2017, Duchateau, et al 2020. The accuracy of these temporal profiles was not tested in the current study.…”

“…Similarly, although the spatial distribution of the segmental strain values across the ventricle can provide valuable information, we could only test the accuracy of detecting these patterns technically by reporting the normalized cross-correlation coefficients with the ground truth distribution. How this impacts clinical readings remains to be tested where initial reports have recently become available (Duchateau, et al 2020).…”