Clinical Investigations
Studies of Right Ventricular and Left Atrial Strain
Comparison between Nondedicated and Novel Dedicated Tracking Tool for Right Ventricular and Left Atrial Strain

https://doi.org/10.1016/j.echo.2021.11.011Get rights and content

Highlights

  • RV and LA speckle-tracking was performed with LV and dedicated RV/LA software.

  • Dedicated RV-tracking software had similar measurement values and reproducibility.

  • Dedicated LA-tracking software had similar values but better reproducibility.

Background

Recently, dedicated speckle-tracking solutions for right ventricular (RV) and left atrial (LA) strain assessment have become commercially available. The purpose of this study was to assess the level of agreement between nondedicated (left ventricular [LV] tracking software) and novel dedicated tracking software for RV and LA strain.

Methods

In 200 patients with various cardiovascular pathologies, we measured global longitudinal strain (GLS), free wall strain (FWS), and segmental values, as well as LA strain during reservoir, conduit, and contraction phases, by using the (1) LV-tracking software and (2) the novel dedicated tracking software for RV or LA strain analysis. Agreement between corresponding measurements obtained with the LV and dedicated RV or LA software was determined by using mean absolute difference (MAD) and Bland-Altman test. The intra- and interobserver reproducibility related to the nondedicated and novel dedicated tracking software was tested in 30 randomly selected subjects.

Results

The dedicated RV-tracking software provided slightly lower strain values without reaching statistical significance. The agreement between software was best for RV GLS (MAD, 2.4 ± 1.8) and significantly poorer for segmental values (MAD ranging from 4.5 ± 3.8 to 5.1 ± 4.0; analysis of variance, P < .05). The intra- and interobserver reproducibility for RV measurements was similar with both software (P > .05 for all parameters). Left atrial mean values showed no statistical difference when obtained with the two tracking tools. The use of LA dedicated tracking software increased significantly the intra- and interobserver reproducibility for LA strain during reservoir and atrial contraction (P < .01 for both).

Conclusions

Our results suggest that the choice of tracking software does not significantly impact RV strain measurements. Nonetheless, the use of the same tracking software is recommended when performing serial measurements. The use of the dedicated software for LA strain analysis significantly improved the intra- and interobserver reproducibility.

Section snippets

Study Population

For our study, we retrospectively selected 200 echocardiographic recordings performed in the echocardiography laboratory of the University Hospitals Leuven, Belgium. Echocardiographic recordings were considered appropriate for the study when the following criteria were met: (1) presence of images suitable for LA and RV strain measurements; (2) image quality acceptable for speckle-tracking; (3) sinus rhythm with stable electrocardiogram. The ethical commission of the hospital has waived the

Patient Characteristics

We included 200 subjects (138 male patients, 69%) with normal echocardiographic findings (n = 75, 38%) as well as a wide range of cardiac pathology such as myocardial ischemia (n = 65, 33%), dilated cardiomyopathy (n = 40, 20%), and hypertrophic hearts (n = 20, 10%). The ejection fraction in the cohort ranged from 12% to 75%. Patient characteristics and standard echocardiographic measurements of the study group are summarized in Table 1.

Agreement between LV- and Dedicated RV-Tracking Software

Right ventricular strain measurements could be obtained in

Discussion

The growing use of both RV and LA strain measurements in clinical practice has led to the development of tracking tools, tailored to the myocardial shape and motion pattern of the respective chambers. Our study aimed at engaging two aspects: whether the LV and dedicated LA- or RV-tracking software provide interchangeable results and whether the use of dedicated RV- and LA-tracking tools reduces the measurement variability.

Conclusion

Our results suggest that the choice of software used to obtain RV strain values has a minor impact on measurement results. Values and measurement variability did not differ in most of the cases. The direct provision of a more robust RV FWS, easier handling, and correct segmental annotation might be an advantage of the dedicated RV software. For LA strain measurements, the use of dedicated LA tracking provided similar values at a significantly lower variability, suggesting a benefit for clinical

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Conflicts of Interest: None.

JUV is supported by a personal research mandate of the Research Foundation Flanders (FWO), grant no. 183292N. JD is supported by a postdoctoral research mandate of the FWO, grant no. 12ZZN22N.

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