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Two-Dimensional Strain is more Precise than Conventional Measures of Left Ventricular Systolic Function in Pediatric Patients

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Abstract

Ejection fraction (EF) and fractional shortening (FS) are standard methods of quantifying left ventricular (LV) systolic function. 2D global longitudinal strain (2D GLS) is a well-established, but underutilized method for LV function quantification. The aim of this study was to assess precision of GLS compared to EF & FS in pediatrics. Echocardiograms were prospectively analyzed by 2 blinded observers. FS, EF, and GLS were calculated following standard methods. Bland–Altman was applied to assess agreement. Intraclass correlation coefficient (ICC) was used to measure reliability. Coefficient of variation was used to demonstrate relative variability between methods. 103 pediatric echos were evaluated for inter-observer reproducibility, and 15 patients for intra-observer reproducibility. GLS had higher inter-observer agreement and reliability (bias 7%, 95% LOA − 3.4 to + 3.5, ICC 0.86 CI 0.80–0.90) compared to EF (bias 27%, 95% LOA − 18.9 to + 19.5; ICC 0.25 CI 0.07–0.43) and FS (bias 12%, 95% LOA − 11.9 to + 12.2; ICC 0.53 CI 0.38–0.66). GLS also had higher intra-observer agreement (bias 4%, 95% LOA − 3.6 to + 3.7; ICC 0.87 CI 0.66–0.96) compared to EF (bias 11%, 95% LOA − 14.9 to + 15.1; ICC 0.26 CI −  0.28–0.67) and FS (bias 12%, 95% LOA − 12.2 to + 12.5; ICC 0.38 CI − 0.15–0.74). GLS is a more precise method for quantifying LV function in pediatrics, with lower variability compared to EF and FS. GLS provides a more reliable evaluation of LV systolic function and should be utilized more widely in pediatrics.

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Abbreviations

GLS:

Global longitudinal Lagrangian strain

ICC:

Intraclass correlation coefficient

CV:

Coefficient of variation

2D STE:

Two-dimensional speckle tracking echocardiography

LV:

Left ventricular

Obs:

Observer

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Acknowledgements

The authors wish to thank the sonographers and staff at the Heart Station, St. Louis Children’s Hospital for their contributions to echocardiographic acquisitions related to this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA

    Meghna D. Patel, Craig Myers, Gautam K. Singh & Shafkat Anwar

  2. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

    Kazuaki Negishi

  3. Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University, 750 Welch Road, Suite 321, Palo Alto, CA, 94304, USA

    Meghna D. Patel

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  1. Meghna D. Patel
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  2. Craig Myers
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  4. Gautam K. Singh
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  5. Shafkat Anwar
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Correspondence to Meghna D. Patel.

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Patel, M.D., Myers, C., Negishi, K. et al. Two-Dimensional Strain is more Precise than Conventional Measures of Left Ventricular Systolic Function in Pediatric Patients. Pediatr Cardiol 41, 186–193 (2020). https://doi.org/10.1007/s00246-019-02243-8

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  • DOI: https://doi.org/10.1007/s00246-019-02243-8

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