Left ventricular strain measured by feature-tracking cardiac magnetic resonance imaging and 2D speckle-tracking echocardiography in chronic ischemic heart disease: an intermodality agreement study

Background Global longitudinal strain (GLS) is a valuable tool for assessing left ventricular (LV) systolic function, detecting subclinical dysfunction earlier than classic ejection fraction. Two-dimensional speckle-tracking echocardiography (2D-STE) is widely used due to its accessibility and high temporal resolution, whereas feature-tracking cardiac magnetic resonance (FT-CMR) offers superior spatial resolution and reproducibility. In this study, we assess the relationships between longitudinal strain measurements obtained by 2D-STE and FT-CMR in patients with chronic ischemic heart disease (IHD). Methods Fifty-five patients with IHD and left ventricular ejection fraction (LVEF) ≤ 49% underwent 2D-STE and FT-CMR at least 3 months after an acute coronary event. Global and segmental longitudinal strain for all 17 myocardial segments was measured using both modalities. Pearson correlation and Bland–Altman analysis were used to assess correlation and agreement, respectively. Results GLS showed a strong correlation between 2D-STE and FT-CMR (r = 0.793, P < 0.001), with a mean difference of 0.98% and limits of agreement from –3.2% to + 5.1%. Segmental strain demonstrated greater variability (r = 0.03 to 0.47), with the best agreement in mid and apical segments and greatest discrepancies at the basal level. Conclusions In patients with IHD and reduced LVEF, GLS obtained by FT-CMR and 2D-STE showed strong correlation and acceptable overall agreement. However, the relatively wide limits of agreement and variability in segmental strain, particularly in basal regions, indicate that the two methods are not fully interchangeable for individual assessment and follow-up. Both techniques reflect similar physiological trends but differ in absolute values, requiring caution in regional strain interpretation.