Reproducibility of Combined Acquisition and Measurement of Left Ventricular Longitudinal Peak Segmental Strain in Relation to the Severity of Left Ventricular Dysfunction

Abstract

Background: Whether left ventricular (LV) longitudinal peak systolic segmental strain (LPSS) has sufficient reproducibility to be used in clinical practice (e.g., in patient follow-up) remains unclear. The aim of this study was to assess the reproducibility of combined acquisition and measurements of LPSS across the spectrum of LV ejection fraction (LVEF).

Methods: In this prospective study, 72 subjects (mean age, 63 ± 14 years; 65% men) were included in four equal groups: group 1, LVEF ≥ 50%, healthy; group 2, LVEF ≥ 50%, presence of cardiovascular disease and/or risk factors; group 3, LVEF 30%-49%; and group 4, LVEF ≤ 29%. Two observers performed four sets of image acquisitions and measurements (three during the same session, one after a median of 1 day) to account for intraobserver, interobserver, and test-retest reproducibility of combined acquisition and measurements. LPSS was measured in each of the 17 LV segments.

Results: On average, the intraobserver and test-retest intraclass correlation coefficients and mean absolute differences of repeated acquisition and measurement of LPSS were similar across groups. However, interobserver intraclass correlation coefficients and mean absolute differences decreased in group 4 compared with groups 1 to 3. The intraobserver, test-retest, and interobserver coefficients of variation of all LV segments became worse as LVEF decreased, especially in group 4, in which LPSS was not reproducible in most segments. Reproducibility of LPSS in basal LV segments was worse compared with apical segments. The average measurement uncertainty (defined as the 95% limits of agreement of repeated acquisition and measurements) of LPSS in a test-retest scenario was ±8.9%, ±11.8%, ±10.7%, and ±9.0% in groups 1, 2, 3, and 4, respectively.

Conclusions: The clinical applicability of LPSS is hindered by suboptimal reproducibility, even if a single observer repeats both acquisition and measurements. Changes in LPSS during patient follow-up should be interpreted with caution.

Keywords: Echocardiography; Left ventricular dysfunction; Reproducibility; Segmental strain.