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Comparison of left ventricular manual versus automated derived longitudinal strain: implications for clinical practice and research

  • Yukari Kobayashi
  • Miyuki Ariyama
  • Yuhei Kobayashi
  • Genevieve Giraldeau
  • Dominik Fleischman
  • Mirta Kozelj
  • Bojan Vrtovec
  • Euan Ashley
  • Tatiana Kuznetsova
  • Ingela Schnittger
  • David Liang
  • Francois Haddad
Original Paper

Abstract

Systolic global longitudinal strain (GLS) is emerging as a useful metric of ventricular function in heart failure and usually assessed using post-processing software. The purpose of this study was to investigate whether longitudinal strain (LS) derived using manual-tracings of ventricular lengths (manual-LS) can be reliable and time efficient when compared to LS obtained by post-processing software (software-LS). Apical 4-chamber view images were retrospectively examined in 50 healthy controls, 100 patients with dilated cardiomyopathy (DCM), and 100 with hypertrophic cardiomyopathy (HCM). We measured endocardial and mid-wall manual-LS and software-LS, using peak of average regional curve [software-LS(a)] and global ventricular lengths [software-LS(l)] according to definition of Lagragian strain. We compared manual-LS and software-LS by using Bland–Altman plot and coefficient of variation (COV). In addition, test–retest was also performed for further assessment of variability in measurements. While manual-LS was obtained in all subjects, software-LS could be obtained in 238 subjects (95 %). The time spent for obtaining manual-LS was significantly shorter than for the software-LS (94 ± 39 s vs. 141 ± 79 s, P < 0.001). Overall, manual-LS had an excellent correlation with both software-LS (a) (R2 = 0.93, P < 0.001) and software-LS(l) (R2 = 0.84, P < 0.001). The bias (95 %CI) between endocardial manual-LS and software-LS(a) was 0.4 % [−2.8, 3.6 %] in absolute and 3.5 % [−17.0, 24.0 %] in relative difference while it was 0.4 % [−2.5, 3.3 %] and 3.4 % [−16.2, 23.1 %], respectively with software-LS(l). Mid-wall manual-LS and mid-wall software-LS(a) also had good agreement [a bias (95 % CI) for absolute value of 0.1 % [−2.1, 2.5 %] in HCM, and 0.2 % [−2.2, 2.6 %] in controls]. The COV for manual and software derived LS were below 6 %. Test–retest showed good variability for both methods (COVs were 5.8 and 4.7 for endocardial and mid-wall manual-LS, and 4.6 and 4.9 for endocardial and mid-wall software-LS(a), respectively. Manual-LS appears to be as reproducible as software-LS; this may be of value especially when global strain is the metric of interest.

Keywords

Echocardiography Strain imaging Global longitudinal strain Post-processing software Vendor-independent Ventricular function Heart failure Hypertrophic cardiomyopathy Dilated cardiomyopathy 

Abbreviations

COV

Coefficient of variation

DCM

Dilated cardiomyopathy

EF

Ejection fraction

HCM

Hypertrophic cardiomyopathy

LS

Longitudinal strain

LV

Left ventricular

LVEDV

Left ventricular end-diastolic volume

LVESV

Left ventricular end-systolic volume

Notes

Acknowledgments

We want to thank the Stanford Cardiovascular Institute as well as the Pai Chan Lee Research Fund for their support.

Compliance with ethical standards

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Yukari Kobayashi
    • 1
    • 2
  • Miyuki Ariyama
    • 1
    • 2
  • Yuhei Kobayashi
    • 1
    • 2
  • Genevieve Giraldeau
    • 1
    • 2
  • Dominik Fleischman
    • 1
    • 2
  • Mirta Kozelj
    • 1
    • 2
  • Bojan Vrtovec
    • 1
    • 2
  • Euan Ashley
    • 1
    • 2
  • Tatiana Kuznetsova
    • 2
    • 3
  • Ingela Schnittger
    • 1
    • 2
  • David Liang
    • 1
    • 2
  • Francois Haddad
    • 1
    • 2
  1. 1.Division of Cardiovascular MedicineStanford University School of MedicineStanfordUSA
  2. 2.Stanford Cardiovascular InstituteStanfordUSA
  3. 3.Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular SciencesUniversity of LeuvenLouvainBelgium

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