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. 2019 Sep 2;17(1):18.
doi: 10.1186/s12947-019-0168-9.

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

Sigve Karlsen  1 , Thomas Dahlslett  1 , Bjørnar Grenne  1   2 , Benthe Sjøli  1 , Otto Smiseth  3 , Thor Edvardsen  3 , Harald Brunvand  4
Affiliations

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

Sigve Karlsen et al. Cardiovasc Ultrasound. .

Abstract

Background: Left ventricular ejection fraction (LVEF) is an established method for evaluation of left ventricular (LV) systolic function. Global longitudinal strain (GLS) by speckle tracking echocardiography seems to be an important additive method for evaluation of LV function with improved reproducibility compared with LVEF. Our aim was to compare reproducibility of GLS and LVEF between an expert and trainee both as echocardiographic examiner and analyst.

Methods: Forty-seven patients with recent Acute Coronary Syndrome (ACS) underwent echocardiographic examination by both an expert echocardiographer and a trainee. Both echocardiographers, blinded for clinical data and each other's findings, performed image analysis for evaluation of intra- and inter- observer variability. GLS was measured using speckle tracking echocardiography. LVEF was calculated by Simpson's biplane method.

Results: The trainee measured a GLS of - 19.4% (±3.5%) and expert - 18.7% (±3.2%) with an Intra class correlation coefficient (ICC) of 0.89 (0.74-0.95). LVEF by trainee was 50.3% (±8.2%) and by expert 53.6% (±8.6%), ICC coefficient was 0.63 (0.32-0.80). For GLS the systematic difference was 0.21% (- 4.58-2.64) vs. 4.08% (- 20.78-12.62) for LVEF.

Conclusion: GLS is a more reproducible method for evaluation of LV function than LVEF regardless of echocardiographic training.

Keywords: Echocardiographic training; Global longitudinal strain; Left ventricular ejection fraction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Images obtained by expert echocardiographer analyzed by both trainee and expert. Scatterplot for GLS (a) and LVEF (b). Bland-Altman plot for GLS (c) and LVEF (d). Dotted line illustrates 95% confidence interval and colored dotted line illustrate fixed bias
Fig. 2
Fig. 2
Images obtained by trainee echocardiographer analyzed by both trainee and expert. Scatterplot for GLS (a) and LVEF (b). Bland-Altman plot for GLS (c) and LVEF (d). Dotted line illustrates 95% confidence interval and colored dotted line illustrate fixed bias
Fig. 3
Fig. 3
Analysis of expert analysis of expert images versus trainee analysis of trainee images. Scatterplot for GLS (a) and LVEF (b). Bland-Altman plot for GLS (c) and LVEF (D). Dotted line illustrates 95% confidence interval and colored dotted line illustrate fixed bias
Fig. 4
Fig. 4
Trainee analyzing images obtained by both expert and trainee. Scatterplot for GLS (a) and LVEF (b). Bland-Altman plot for GLS (c) and LVEF (d). Dotted line illustrates 95% confidence interval and colored dotted line illustrate fixed bias
Fig. 5
Fig. 5
Expert analyzing images obtained by both expert and trainee. Scatterplot for GLS (a) and LVEF (b). Bland-Altman plot for GLS (c) and LVEF (d). Dotted line illustrates 95% confidence interval and colored dotted line illustrate fixed bias
Fig. 6
Fig. 6
Correlation of EDD and E/E’ in trainee analysis of trainee and expert images displayed in scatterplot and Bland-Altman plot. Dotted line illustrates 95% confidence interval
See this image and copyright information in PMC

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