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. 2022 Apr 25;11(9):2402.
doi: 10.3390/jcm11092402.

The Agreement of a Two- and a Three-Dimensional Speckle-Tracking Global Longitudinal Strain

Jiří Plášek  1   2   3 , Tomáš Rychlý  2   3 , Diana Drieniková  1   2 , Ondřej Cisovský  2   3 , Tomáš Grézl  1   3 , Miroslav Homza  2   3 , Jan Václavík  1   3
Affiliations

The Agreement of a Two- and a Three-Dimensional Speckle-Tracking Global Longitudinal Strain

Jiří Plášek et al. J Clin Med. .

Abstract

Background: Two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE) enables assessment of myocardial function. Here, we examined the agreement between 2D and 3D STE measurement of a global longitudinal strain (GLS) in patients with normal left ventricle, reduced ejection fraction, and cardiac pacing. Methods: Our analysis included 90 consecutive patients (59% males; average age: 73.2 ± 11.2 years) examined between May 2019−December 2020, with valid 2D and 3D loops for further speckle-tracking strain analysis. Linear regression, Pearson correlation, and a Bland−Altman plot were used to quantify the association between 2D and 3D GLS and related segments, using the 17-segment American Heart Association (AHA) model. Analyses were performed in the entire study group and subgroups. Intra- and inter-observer variability of 2D and 3D GLS measurement was also performed in all participants. Results: We observed a strong correlation between 2D and 3D GLS measurements (R = 0.76, p < 0.001), which was higher in males (R = 0.78, p < 0.001) than females (R = 0.69, p < 0.001). Associated segment correlation was poor (R = 0.2−0.5, p < 0.01). The correlation between 2D and 3D GLS was weaker in individuals with ventricular pacing of >50% (R = 0.62, p < 0.001) than <50% (R = 0.8, p < 0.001), and in patients with LVEF of <35% (R = 0.69, p = 0.002) than >35% (R = 0.72, p < 0.001). Intra-observer variability for 2D and 3D GLS was 2 and 2.3%, respectively. Inter-observer variability for 2D and 3D GLS was 3.8 and 3.6%, respectively Conclusion: Overall 2D and 3D GLS were closely associated but not when analyzed per segment. It seems that GLS comparison is more representative of global shortening than local displacement. Right ventricular pacing and reduced left ventricular ejection fraction were associated with a reduced correlation between 2D and 3D GLS.

Keywords: 17-segment AHA model; deformation imaging; global longitudinal strain; speckle-tracking echocardiography; three-dimensional echocardiography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Four–chamber view of automatic function imaging (AFI), peak systolic strain is visualized in the left lower part, global strain in the left upper part and corresponding waveforms in the right upper part, right lower part visualize surface extrapolated color mapped strain.
Figure 2
Figure 2
Automatic left ventricular quantification (AutoLVQ) plane after segmentation process with bull’s eye reconstruction of 3D global longitudinal strain. Red color and more negative number means better contractility as opposed to positive numbers and blue colour.
Figure 3
Figure 3
Scatter plot of 2D vs. 3D global longitudinal strain, linear regression equation displayed in the left upper section.
Figure 4
Figure 4
Bland–Altman plot of mean values of 2D + 3D global longitudinal strain (GLS, x axis) and the difference between 2D and 3D GLS. Upper and lower limit of agreement displayed as red dotted line with respective values.
Figure 5
Figure 5
Scatter plot of 2D vs. 3D global longitudinal strain. Sorted by the amount of right ventricular pacing (VP) with displayed regression equation.
Figure 6
Figure 6
Scatter plot of 2D vs. 3D global longitudinal strain sorted by left ventricular ejection fraction (LV EF) with displayed regression equation.
See this image and copyright information in PMC

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