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Comparative Study
. 2020 Mar;36(3):431-439.
doi: 10.1007/s10554-019-01732-4. Epub 2019 Nov 13.

Contrast-enhanced echocardiographic measurement of longitudinal strain: accuracy and its relationship with image quality

Ilya Karagodin  1 , Davide Genovese  1   2 , Eric Kruse  1 , Amit R Patel  1 , Nina Rashedi  1 , Roberto M Lang  1 , Victor Mor-Avi  3
Affiliations
Comparative Study

Contrast-enhanced echocardiographic measurement of longitudinal strain: accuracy and its relationship with image quality

Ilya Karagodin et al. Int J Cardiovasc Imaging. 2020 Mar.

Abstract

The importance of left ventricular (LV) global longitudinal strain (GLS) is increasingly recognized in multiple clinical scenarios. However, in patients with poor image quality, strain is difficult or impossible to measure without contrast enhancement. The feasibility of contrast-enhanced GLS measurement was recently demonstrated. We sought to determine: (1) whether contrast enhancement improves the accuracy of GLS measurements against cardiac magnetic resonance (CMR) reference, (2) their reproducibility compared to non-enhanced GLS, and (3) the dependence of accuracy and reproducibility on image quality. We prospectively enrolled 25 patients undergoing clinically indicated CMR imaging who subsequently underwent transthoracic echocardiography (TTE) with and without low-dose contrast injection (1-2 mL Optison/3-5 mL saline IV, GE Healthcare). GLS was measured from both non-contrast and contrast-enhanced images using speckle tracking (EchoInsight, Epsilon Imaging). These measurements were compared to each other and to CMR reference values obtained using feature tracking (SuiteHEART, NeoSoft). Inter-technique comparisons included linear regression and Bland-Altman analyses. A random subgroup of 15 patients was used to assess inter- and intra-observer variability using intra-class correlation (ICC). Contrast-enhanced GLS was in close agreement with non-enhanced GLS (r = 0.95; bias: - 0.2 ± 1.5%). Both inter-observer (ICC = 0.88 vs. 0.82) and intra-observer variability (ICC = 0.91 vs. 0.88) were improved by contrast enhancement. The agreement with CMR was better for contrast-enhanced GLS (r = 0.87; bias: 1.1 ± 2.2%) than for non-enhanced GLS (r = 0.80; bias: 1.3 ± 2.7%). In 12/25 patients with suboptimal TTE images that rendered GLS difficult to measure, contrast-enhanced GLS showed better agreement with CMR than non-enhanced GLS (r = 0.88 vs. 0.83) and also improved inter-observer (ICC = 0.83 vs. 0.76) and intra-observer variability (ICC = 0.88 vs. 0.82). In conclusion, contrast enhancement of TTE images improves the accuracy and reproducibility of GLS measurements, resulting in better agreement with CMR, even in patients with suboptimal acoustic windows. This approach may aid in the assessment of LV function in this patient population.

Keywords: Contrast enhancement; Left ventricular function; Myocardial strain; Speckle-tracking echocardiography.

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Conflict of interest statement

Compliance with ethical standards

Conflict of interest All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Non-enhanced echocardiographic GLS measured using speckle tracking software from apical four- (top middle), two- (bottom left), and three-chamber windows (bottom right). See text for details
Fig. 2
Fig. 2
Contrast-enhanced echocardiographic GLS measured using speckle tracking software from apical four- (top middle), two- (bottom left), and three-chamber windows (bottom right). See text for details
Fig. 3
Fig. 3
CMR-derived GLS measured using feature tracking software from two-, three-, and four-chamber cine stacks. See text for details
Fig. 4
Fig. 4
Results of linear regression (top) and Bland–Altman (bottom) analyses comparing echocardiographic measurements of global longitudinal strain obtained from non-enhanced (left) and contrast-enhanced (right) images against CMR reference values
See this image and copyright information in PMC

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