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September 2, 2019Cardiovascular UltrasoundOpen Access

Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training

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Key result

Global longitudinal strain demonstrated significantly higher inter-observer reproducibility than left ventricular ejection fraction (ICC 0.89 vs 0.63, p<0.001) regardless of echocardiographic training.

Why the study?

GLS by speckle tracking echocardiography appears to offer improved reproducibility over LVEF, but comparisons between experts and trainees as examiners and analysts were needed.

Does global longitudinal strain provide better reproducibility than left ventricular ejection fraction for evaluating left ventricular function regardless of echocardiographic training in patients with recent ACS?

Comparison

GLS vs LVEF reproducibility between an expert and a trainee

Design

Blinded reproducibility study

Authors

SKSigve KarlsenUniversity of OsloTDThomas DahlslettHospital of Southern NorwayBGBjørnar GrenneCardiac Imaging

Discussion

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Implication

Supports GLS for reproducible LV assessment post-ACS; hypothesis-generating for practice change pending outcome trials.

Study Design

Type

Cross-Sectional (n=47)

Blinding

Blinded to clinical data and each other's findings

Multicenter

No

Structured PICO

Does global longitudinal strain provide better reproducibility than left ventricular ejection fraction for evaluating left ventricular function regardless of echocardiographic training in patients with recent ACS?

P
Population
47 patients with recent suspected non-ST elevation acute coronary syndrome underwent double echocardiographic examination by an expert and a trainee to compare the reproducibility of GLS and LVEF.
E
Exposure
Global longitudinal strain (GLS) measurement by speckle tracking echocardiography
C
Comparator
Left ventricular ejection fraction (LVEF) calculation by Simpson's biplane method
O
Outcome
Intra- and inter-observer variability (reproducibility) between an expert and a traineesurrogate

Main Result

Absolute Event Rate: 0.89% vs 0.63%

p-value: p=<0.001

Global longitudinal strain provides a more reproducible assessment of left ventricular function than ejection fraction, even when performed by operators with different levels of training.

Limitations

  • No industrial standard for strain analysis among different echocardiographic machine vendors, meaning results may not be interchangeable between vendors.
  • Identical equipment must be used when comparing examinations.
  • Limited software available for automated LVEF measurement that could reduce inter-observer reproducibility.

Cite This Study

Karlsen et al. (2019) conducted a cross-sectional in Suspected non-ST elevation acute coronary syndrome (NSTE-ACS) (n=47). Global longitudinal strain (GLS) by speckle tracking echocardiography vs. Left ventricular ejection fraction (LVEF) by Simpson's biplane method was evaluated on Inter-observer reproducibility (Intra class correlation coefficient) when each operator analyzed their own images (95% CI 0.74-0.95, p=<0.001). Global longitudinal strain demonstrated significantly higher inter-observer reproducibility than left ventricular ejection fraction (ICC 0.89 vs 0.63, p<0.001) regardless of echocardiographic training.

synapsesocial.com/papers/6a209ac86236d09b9bcd2c23https://doi.org/10.1186/s12947-019-0168-9
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome2010 · 100 citations
  2. 2Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function1997 · 399 citations
  3. 3Reproducibility and experience dependence of echocardiographic indices of left ventricular function: Side‐by‐side comparison of global longitudinal strain and ejection fraction2017 · 59 citations
  4. 4Prediction of All-Cause Mortality and Heart Failure Admissions From Global Left Ventricular Longitudinal Strain in Patients With Acute Myocardial Infarction and Preserved Left Ventricular Ejection Fraction2013 · 409 citations
  5. 5Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction2014 · 1,071 citations