Feasibility and reproducibility of the fully-automated strain analysis in a healthy population: a comparative study with the manual analysis

Purpose: The feasibility of strain analysis in clinical practice was hindered by two reasons: time-consuming and a lack of specific analytic packages for the right ventricle and atria. A novel software called Autostrain automatically tracks the myocardium for strain analysis. This study aimed to evaluate the feasibility and reproducibility of the automatic analysis method in a healthy population and compare it with the manual method. Methods: Two trained doctors performed strain analysis of the left ventricle (LV), left atrium (LA), right ventricle (RV), and right atrium (RA) using automatic and manual methods (Qlab software) in 159 healthy volunteers. The reproducibility of automatic analysis between two consecutive cardiac cycles was assessed. Results: The feasibility of automatic analysis in LV, LA, RV, and RA were 145/152(95.4%), 151/152(99.3%), 143/152(94.1%), 149/152(98.0%), respectively. For the measurement of global longitudinal strain (GLS), a good correlation was shown between the automatic results of two consecutive cardiac cycles (r=0.742-0.854, P＜0.001). No significant differences in LV-GLS between the two methods were shown (-21.1%±2.4% vs. -20.8%±2.4%, P=0.05). The RV free-wall, LA, and RA global longitudinal strain measured by the automatic software significantly differed from the manual analysis. The automated method had a significantly shorter analysis time than the manual method. Conclusion: The novel, fully-automatic myocardium strain analysis software can provide a rapid assessment with high reproducibility, which is more feasible and adaptable in clinical practice. It should be noted that strain values measured by automatic and manual analysis cannot be used interchangeably.