Clinical Investigation
Reproducibility of Left Ventricular Strain
Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors: The EACVI/ASE Inter-Vendor Comparison Study

https://doi.org/10.1016/j.echo.2015.06.011Get rights and content

Highlights

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    Strain measurements from nine machine and software vendors were compared in 62 subjects.

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    GLS reproducibility was superior to conventional echocardiographic measures.

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    Small but significant differences between vendors were detected.

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    GLS may be used in clinical practice.

Background

This study was planned by the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging to (1) test the variability of speckle-tracking global longitudinal strain (GLS) measurements among different vendors and (2) compare GLS measurement variability with conventional echocardiographic parameters.

Methods

Sixty-two volunteers were studied using ultrasound systems from seven manufacturers. Each volunteer was examined by the same sonographer on all machines. Inter- and intraobserver variability was determined in a true test-retest setting. Conventional echocardiographic parameters were acquired for comparison. Using the software packages of the respective manufacturer and of two software-only vendors, endocardial GLS was measured because it was the only GLS parameter that could be provided by all manufactures. We compared GLSAV (the average from the three apical views) and GLS4CH (measured in the four-chamber view) measurements among vendors and with the conventional echocardiographic parameters.

Results

Absolute values of GLSAV ranged from 18.0% to 21.5%, while GLS4CH ranged from 17.9% to 21.4%. The absolute difference between vendors for GLSAV was up to 3.7% strain units (P < .001). The interobserver relative mean errors were 5.4% to 8.6% for GLSAV and 6.2% to 11.0% for GLS4CH, while the intraobserver relative mean errors were 4.9% to 7.3% and 7.2% to 11.3%, respectively. These errors were lower than for left ventricular ejection fraction and most other conventional echocardiographic parameters.

Conclusion

Reproducibility of GLS measurements was good and in many cases superior to conventional echocardiographic measurements. The small but statistically significant variation among vendors should be considered in performing serial studies and reflects a reference point for ongoing standardization efforts.

Section snippets

Study Population

Study subjects were recruited among those referred to the routine echocardiography laboratory of our institution and from the coworkers of our research center. We included both patients with a variety of LV functional states and subjects with normal cardiac function. The main inclusion criteria were age ≥ 18 years, ability to consent, ability to walk and to lie in a supine position for 2 hours, good echocardiographic imaging windows, and regular heart rhythm. In total, 63 subjects were

Results

Sixty-two of the 63 invited persons participated in the scanning, and a total of 1,302 echocardiographic examinations could be performed. For an individual study participant, no relevant changes in blood pressure were observed during the course of the entire scanning session. Furthermore, no differences in blood pressure were observed between machines. EFs in our study population ranged from 35% to 78%, with 14 participants having EFs < 55%. The average EF of the study population was 60%.

Main Findings

This is the first study to directly compare GLS measurements obtained with STE from 7 different ultrasound machine vendors and two software-only vendors in a group of volunteers with LV function ranging from normal to severely impaired. Our main findings can be summarized as follows: (1) GLS measurements with STE are highly feasible in patients with sufficient image quality, (2) there was moderate but statistically significant intervendor variability in GLSAV and GLS4CH measurements, and (3)

Conclusion

This was the first study performing a head-to-head comparison of GLS measurements using speckle-tracking echocardiographic software packages from seven different ultrasound machine vendors and two software-only vendors in a group of volunteers with a wide range of LV EFs. In a well-controlled setting, close to clinical reality, we could demonstrate that STE-based GLS measurements are feasible in patients with sufficient image quality. The inter- and intraobserver reproducibility of GLS proved

Acknowledgments

The authors thank all industry partners for their active support of this project, their constructive contribution to its realization, and the open and fair discussion of the protocol and the study results. The authors appreciate that no attempt has been made to influence data analysis or presentation. The authors thank Valerie Robesyn for her excellent logistic support and help with patient recruitment; their technicians, Marleen Franken, Frieda Martens, Suzanne Terweduwe, Anita Tuteleers,

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    • Cited by (0)

    A report on behalf of the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging and the participating companies: Luigi P. Badano, Padua, Italy (task force co-chair, European Association of Cardiovascular Imaging); James D. Thomas, Cleveland, Ohio (task force co-chair, American Society of Echocardiography); Jamie Hamilton (Epsilon); Sean Lucas (Epsilon); Stefano Pedri (Esaote); Peter Lysyansky (GE); Gunnar Hansen (GE); Yasuhiro Ito (Hitachi Aloka Medical); Rachid Redouane (Hitachi Medical Systems Europe); Jane Vogel (Philips); David Prater (Philips); Joo Hyun Song (Samsung); Jin Yong Lee (Samsung); Helene Houle (Siemens); Bogdan Georgescu (Siemens); Rolf Baumann (TomTec); Bernhard Mumm (TomTec); Yashuhiko Abe (Toshiba); and Willem Gorissen (Toshiba).

    Dr Farsalinos received a research grant from the Greek Society of Cardiology. Dr Daraban received a grant from the European Heart Failure Association. Dr Ünlü received a grant from the Erasmus Lifelong Learning Programme. Dr Voigt holds a personal research mandate of the Flemish Research Foundation and received a research grant of the University Hospital Gasthuisberg.

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