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Journal of the American Society of Echocardiography

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Feasibility, Reproducibility, and Prognostic Value of Fully Automated Measurement of Right Ventricular Longitudinal Strain - 01/06/22

Doi : 10.1016/j.echo.2022.01.016 
Yuman Li, MD, PhD a, b, c, Chenchen Sun, MD a, b, c, Li Zhang, MD, PhD, FASE a, b, c, d, Yanting Zhang, MD a, b, c, Jing Wang, MD, PhD a, b, c, Jing Zhang, MD, PhD e, Guohua Wang, MD, PhD e, Chun Wu, MD a, b, c, Yuji Xie, MD a, b, c, Shuangshuang Zhu, MD a, b, c, Mingzhu Qian, MD, PhD a, b, c, Lang Gao, MD a, b, c, Meng Li, MD a, b, c, Yixia Lin, MD a, b, c, Yali Yang, MD, PhD a, b, c, Qing Lv, MD, PhD a, b, c, Mingxing Xie, MD, PhD, FASE, FAHA, FACC a, b, c, d, f, ⁎
a Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
b Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China 
c Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China 
d Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen, China 
e Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
f Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China 

∗Reprint requests: Mingxing Xie, MD, PhD, FASE, FAHA, FACC, Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.Department of Ultrasound MedicineUnion HospitalTongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang AvenueWuhan430022China

Abstract

Background

Right ventricular free wall longitudinal strain (RVFWLS) carries important diagnostic and prognostic significance in a variety of clinical settings, but its measurement is time consuming and operator dependent, limiting its value in routine clinical practice. Automated RVFWLS measurements can overcome these limitations. The purpose of this study was to determine the feasibility, reproducibility, and prognostic implications of automated RVFWLS compared with manual assessment of RVFWLS.

Methods

A total of 206 patients with a wide range of right ventricular (RV) function were retrospectively selected for this study. Fully automated (Auto-Strain), semiautomated (automated with editing), and manual (standard manual assessment) RVFWLS were measured using two-dimensional speckle-tracking echocardiography in the same RV-focused apical four-chamber view. RV ejection fraction (RVEF) was measured using three-dimensional echocardiography. Abnormal RV systolic function was defined as RVEF < 45%. Agreement for RVFWLS measurements among the three different methods was based on a combination of Pearson correlation, Bland-Altman analyses, and coefficients of variation (CVs).

Results

Automated RVFWLS measurements were feasible in 204 subjects (99%). Automated (8 ± 1 sec/patient) and semiautomated (50 ± 10 sec/patient) assessments had shorter analysis times compared with manual measurement (103 ± 25 sec/patient, P < .001 for both). Semiautomated RVFWLS had a stronger correlation with manual RVFWLS than automated RVFWLS (r = 0.850 vs r = 0.708, P < .001). Semiautomated RVFWLS had smaller biases, narrower limits of agreement (LOA), and lower CVs against manual assessment in comparison with the fully automated method in the whole study population (bias of 0.62 and 1.15, LOA of 6.54 and 10.50, and CVs of 9.3% and 16.9%, respectively), in the subgroup with RVEF < 45% (bias of 0.81 and 1.43, LOA of 6.32 and 10.42, and CVs of 10.2% and 18.6%, respectively), and in those with RVEF ≥ 45% (bias of 0.34 and 0.73, LOA of 6.86 and 10.63, and CVs of 8.0% and 14.5%, respectively). Seventy-six patients experienced adverse cardiovascular events during a median follow-up period of 26 months. Fully automated, semiautomated, and manual RVFWLS were associated with poor outcomes. The prognostic implications of fully automated RVFWLS were inferior to those of semiautomated and manual RVFWLS. Three RVFWLS measurements were highly reproducible.

Conclusions

Both fully automated and semiautomated RVFWLS provide rapid and reproducible assessments of RV function and carry important prognostic implication. Moreover, the semiautomated approach performs better than the fully automated method. Therefore, semiautomated RVFWLS can provide a better balance between feasibility and clinical significance and displays potential for clinical application.

Le texte complet de cet article est disponible en PDF.

Highlights

•
Fully automated and semiautomated RVFWLS are highly feasible and reproducible.
•
The semiautomated approach performs better than the fully automated method.
•
The prognostic value of automated RVFWLS is inferior to that of semiautomated RVFWLS.
•
The semiautomated method offers a balance between feasibility and clinical relevance.

Le texte complet de cet article est disponible en PDF.

Keywords : Echocardiography, Speckle-tracking imaging, Right ventricular function, Free wall longitudinal strain

Abbreviations : 2D, 3D, AUC, CMR, CV, GLS, ICC, IQR, LOA, LV, NRI, ROC, RV, RVEF, RVFWLS


Plan


 This work was supported by the National Natural Science Foundation of China (grants 81727805 and 81922033), the Key Research and Development Program of Hubei (grants 2020DCD015 and 2021BCA138), the Fundamental Research Funds for the Central Universities (grant 5003530082), and the Shenzhen Science and Technology (grant SGDX20190917094601717).
 Conflicts of interest: None.
 Drs. Y. Li, C. Sun, L. Zhang, Y. Zhang, J. Wang, and J. Zhang contributed equally to this report.


© 2022  American Society of Echocardiography. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 35 - N° 6

P. 609-619 - juin 2022 Retour au numéro
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