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Clinical Research in Cardiology

, Volume 104, Issue 7, pp 591–602 | Cite as

Assessment of global longitudinal strain using standardized myocardial deformation imaging: a modality independent software approach

  • Johannes H. Riffel
  • Marius G. P. Keller
  • Matthias Aurich
  • Yannick Sander
  • Florian Andre
  • Sorin Giusca
  • Fabian aus dem Siepen
  • Sebastian Seitz
  • Christian Galuschky
  • Grigorios Korosoglou
  • Derliz Mereles
  • Hugo A. Katus
  • Sebastian J. BussEmail author
Original Paper

Abstract

Background

Myocardial deformation measurement is superior to left ventricular ejection fraction in identifying early changes in myocardial contractility and prediction of cardiovascular outcome. The lack of standardization hinders its clinical implementation. The aim of the study is to investigate a novel standardized deformation imaging approach based on the feature tracking algorithm for the assessment of global longitudinal (GLS) and global circumferential strain (GCS) in echocardiography and cardiac magnetic resonance imaging (CMR).

Methods

70 subjects undergoing CMR were consecutively investigated with echocardiography within a median time of 30 min. GLS and GCS were analyzed with a post-processing software incorporating the same standardized algorithm for both modalities. Global strain was defined as the relative shortening of the whole endocardial contour length and calculated according to the strain formula.

Results

Mean GLS values were −16.2 ± 5.3 and −17.3 ± 5.3 % for echocardiography and CMR, respectively. GLS did not differ significantly between the two imaging modalities, which showed strong correlation (r = 0.86), a small bias (−1.1 %) and narrow 95 % limits of agreement (LOA ± 5.4 %). Mean GCS values were −17.9 ± 6.3 and −24.4 ± 7.8 % for echocardiography and CMR, respectively. GCS was significantly underestimated by echocardiography (p < 0.001). A weaker correlation (r = 0.73), a higher bias (–6.5 %) and wider LOA (± 10.5 %) were observed for GCS. GLS showed a strong correlation (r = 0.92) when image quality was good, while correlation dropped to r = 0.82 with poor acoustic windows in echocardiography. GCS assessment revealed only a strong correlation (r = 0.87) when echocardiographic image quality was good. No significant differences for GLS between two different echocardiographic vendors could be detected.

Conclusions

Quantitative assessment of GLS using a standardized software algorithm allows the direct comparison of values acquired irrespective of the imaging modality. GLS may, therefore, serve as a reliable parameter for the assessment of global left ventricular function in clinical routine besides standard evaluation of the ejection fraction.

Keywords

Left ventricular function Strain Echocardiography Cardiac magnetic resonance Speckle tracking Feature tracking 

Abbreviations

GLS

Global longitudinal strain

GCS

Global circumferential strain

LV

Left ventricular

EF

Ejection fraction

CMR

Cardiac magnetic resonance imaging

LOA

Limits of agreement

ES

End-systolic

ED

End-diastolic

ESV

End-systolic volume

EDV

End-diastolic volume

SSFP

Steady state free precession

FOV

Filed of view

TR

Repetition time

TE

Echo time

FA

Flip angle

SENC

Strain encoded imaging

MAPSE

Mitral annular plane systolic excursion

Notes

Acknowledgments

We thank our technologists Birgit Hörig, Daniel Helm and Angela Stöcker-Wochele for their excellent technical support. The study was supported by a grant from the B. Braun Stiftung. H. A. K. was supported by the DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung-German Centre for Cardiovascular Research)

Conflict of interest

None.

Supplementary material

For further illustration of the tracking algorithm, 4 representative video files (2 CMR videos and 2 echocardiographic videos for GLS and GCS, respectively) are attached (AVI 986 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Johannes H. Riffel
    • 1
  • Marius G. P. Keller
    • 1
  • Matthias Aurich
    • 1
  • Yannick Sander
    • 1
  • Florian Andre
    • 1
  • Sorin Giusca
    • 1
  • Fabian aus dem Siepen
    • 1
  • Sebastian Seitz
    • 1
  • Christian Galuschky
    • 3
  • Grigorios Korosoglou
    • 1
  • Derliz Mereles
    • 1
  • Hugo A. Katus
    • 1
    • 2
  • Sebastian J. Buss
    • 1
    Email author
  1. 1.Department of CardiologyUniversity of HeidelbergHeidelbergGermany
  2. 2.DZHK (German Centre for Cardiovascular Research), partner site HeidelbergHeidelbergGermany
  3. 3.TomTec Imaging Systems GmbHMunichGermany

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