Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors : The EACVI/ASE Inter-Vendor Comparison Study - 01/10/15

Doi : 10.1016/j.echo.2015.06.011

Konstantinos E. Farsalinos, MD ^a, Ana M. Daraban, MD ^a, Serkan Ünlü, MD ^a, James D. Thomas, MD ^b, Luigi P. Badano, MD, PhD ^c, Jens-Uwe Voigt, MD, PhD ^a,^⁎
^a University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
^b Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
^c Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy

^∗Reprint requests: Jens-Uwe Voigt, MD, PhD, Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Department of Cardiovascular Sciences, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.

Abstract

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 GLS_AV (the average from the three apical views) and GLS_4CH (measured in the four-chamber view) measurements among vendors and with the conventional echocardiographic parameters.

Results

Absolute values of GLS_AV ranged from 18.0% to 21.5%, while GLS_4CH ranged from 17.9% to 21.4%. The absolute difference between vendors for GLS_AV was up to 3.7% strain units (P < .001). The interobserver relative mean errors were 5.4% to 8.6% for GLS_AV and 6.2% to 11.0% for GLS_4CH, 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.

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Highlights

•	Strain measurements from nine machine and software vendors were compared in 62 subjects.
•	GLS reproducibility was superior to conventional echocardiographic measures.
•	Small but significant differences between vendors were detected.
•	GLS may be used in clinical practice.

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Keywords : Deformation, Strain, Left ventricle, Systolic function, Speckle-tracking echocardiography

Abbreviations : ANOVA, ASE, EACVI, EF, GLS, LV, LVEDD, STE, TFS

Plan

Methods

Study Population

Industry Partner Recruitment

Intermachine Comparison

Measurement Variability

Comparison With Other Conventional Echocardiographic Parameters

Discussion

Main Findings

Sources of Measurement Variability

Exploring the Bias of Measurements

Exploring the Variability of Repeated Measurements

Rationale for Investigating Endocardial GLS

Study Limitations

Conclusion

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.