Skip to main content
Download PDF

Impact of image quality on reliability of the measurements of left ventricular systolic function and global longitudinal strain in 2D echocardiography

Echo Research & Practice volume 5, pages 28–39 (2018)Cite this article

Abstract

Background: Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) play important roles in diagnosis and management of cardiac diseases. However, the issue of the accuracy and reliability of LVEF and GLS remains to be solved. Image quality is one of the most important factors affecting measurement variability. The aim of this study was to investigate whether improved image quality could reduce observer variability.

Methods: Two sets of three apical images were acquired using relatively old- and new-generation ultrasound imaging systems (Vivid 7 and Vivid E95) in 308 subjects. Image quality was assessed by endocardial border delineation index (EBDI) using a 3-point scoring system. Three observers measured the LVEF and GLS, and these values and inter-observer variability were investigated.

Results: Image quality was significantly better with Vivid E95 (EBDI: 26.8 ± 5.9) than that with Vivid 7 (22.8 ± 6.3, P < 0.0001). Regarding the inter-observer variability of LVEF, the r-value, bias, 95% limit of agreement and intra-class correlation coefficient for Vivid 7 were comparable to those for Vivid E95. The % variabilities were significantly lower for Vivid E95 (5.3–6.5%) than those for Vivid 7 (6.5–7.5%). Regarding GLS, all observer variability parameters were better for Vivid E95 than for Vivid 7. Improvements in image quality yielded benefits to both LVEF and GLS measurement reliability. Multivariate analysis showed that image quality was indeed an important factor of observer variability in the measurement of LVEF and GLS.

Conclusions: The new-generation ultrasound imaging system offers improved image quality and reduces inter-observer variability in the measurement of LVEF and GLS.

References

  1. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA & Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging 201516 233–270. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ehjci/jev014)

    Article  Google Scholar 

  2. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW & Andrews ML. Prophylactic implantation of defibrillator in patients with myocardial infarction and reduced ejection fraction. New England Journal of Medicine 2002346 877–883. https://doiorg.publicaciones.saludcastillayleon.es/10.1056/NEJMoa013474)

    Article  Google Scholar 

  3. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 2014129 e521–e643. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/CIR.0000000000000031)

    Google Scholar 

  4. Negishi K, Negishi T, Haluska BA, Hare JL, Plana JC & Marwick TH. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. European Heart Journal Cardiovascular Imaging 201415 324–331. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ehjci/jet159)

    Article  Google Scholar 

  5. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J, Sebag IA, Agler DA, Badano LP, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging 201415 1063–1093. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ehjci/jeu192)

    Article  Google Scholar 

  6. Stanton T, Leano R & Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circulation Cardiovascular Imaging 20092 356–364. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/CIRCIMAGING.109.862334)

    Article  Google Scholar 

  7. Ng A, Delgado V, Bertini M, van der Meer RW, Rijzewijk LJ, Shanks M, Nucifora G, Smit JW, Diamant M, Romijn JA, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. American Journal of Cardiology 2009104 1398–1401. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.amjcard.2009.06.063)

    Article  Google Scholar 

  8. Nakai H, Takeuchi M, Nishikage T, Lang RM & Otsuji Y. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. European Journal of Echocardiography 200910 926–932. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ejechocard/jep097)

    Article  Google Scholar 

  9. Barbier P, Mirea O, Cefalu C, Maltagliati A, Savioli G & Guglielmo M. Reliability and feasibility of longitudinal AFI global and segmental strain compared with 2D left ventricular volumes and ejection fraction: intra- and inter-operator, test-retest, and inter-cycle reproducibility. European Heart Journal Cardiovascular Imaging 201516 642–652. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ehjci/jeu274)

    Article  Google Scholar 

  10. Kurt M, Shaikh KA, Peterson L, Kurrelmeyer KM, Shah G, Nagueh SF, Fromm R, Quinones MA & Zoghbi WA. Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort. Journal of the American College of Cardiology 200953 802–810. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2009.01.005)

    Article  Google Scholar 

  11. Jacobs LD, Salgo IS, Goonewardena S, Weinert L, Coon P, Bardo D, Gerard O, Allain P, Zamorano JL, de Isla LP, et al. Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data. European Heart Journal 200627 460–468. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehi666)

    Article  Google Scholar 

  12. Lafitte S, Santos PD, Kerouani A, Robhan T & Roudaut R. Improved reliability for echocardiographic measurement of left ventricular volume using harmonic power imaging mode combined with contrast agent. American Journal of Cardiology 200085 1234–1238. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0002-9149(00)00734-7)

    Article  CAS  Google Scholar 

  13. Spencer KT, Bednarz J, Mor-Avi V, Weinert L, Tan J, Godoy I & Lang RM. The role of echocardiographic harmonic imaging and contrast enhancement for improvement of endocardial border delineation. Journal of the American Society of Echocardiography 200013 131–138. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0894-7317(00)90024-5)

    Article  CAS  Google Scholar 

  14. Kasprzak JD, Paelinck B, Cate FJT, Vletter WB, Jong Nd, Poldermans D, Elhendy A, Bouakaz A & Roelandt JRTC. Comparison of native and contrast-enhanced harmonic echocardiography for visualization of left ventricular endocardial border. American Journal of Cardiology 199983 211–217. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0002-9149(98)00826-1)

    Article  CAS  Google Scholar 

  15. Malm S, Frigstad S, Sagberg E, Larsson H & Skjaerpe T. Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging. Journal of the American College of Cardiology 200444 1030–1035. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2004.05.068)

    Article  Google Scholar 

  16. Takigiku K, Takeuchi M, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K & Nakatani S. Normal range of left ventricular 2-dimensional strain. Circulation Journal 201276 2623–2632. https://doiorg.publicaciones.saludcastillayleon.es/10.1253/circj.CJ-12-0264)

    Article  Google Scholar 

  17. Yoshitani H, Takeuchi M, Hirose M, Miyazaki C, Otani S, Sakamoto K & Yoshikawa J. Head-to-head comparison of fundamental, tissue harmonic and contrast harmonic imaging with or without an air-filled contrast agent, levovist, for endocardial border delineation in patients with poor quality image. Circulation Journal 200266 494–498. https://doiorg.publicaciones.saludcastillayleon.es/10.1253/circj.66.494)

    Article  Google Scholar 

  18. Nagata Y, Takeuchi M, Wu VC, Izumo M, Suzuki K, Sato K, Seo Y, Akashi YJ, Aonuma K & Otsuji Y. Prognostic value of LV deformation parameters using 2D and 3D speckle-tracking echocardiography in asymptomatic patients with severe aortic stenosis and preserved LV ejection fraction. JACC Cardiovascular Imaging 20158 235–245. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jcmg.2014.12.009)

    Article  Google Scholar 

  19. Mor-Avi V, Jenkins C, Kuhl HP, Nesser HJ, Marwick T, Franke A, Ebner C, Freed BH, Steringer-Mascherbauer R, Pollard H, et al. Real-time 3-dimensional echocardiographic quantification of left ventricular volumes: multicenter study for validation with magnetic resonance imaging and investigation of sources of error. JACC Cardiovascular Imaging 20081 413–423. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jcmg.2008.02.009)

    Article  Google Scholar 

  20. Larsson MK, Da Silva C, Gunyeli E, Ilami AA, Szummer K & Winter R, Bjallmark A. The potential clinical value of contrast-enhanced echocardiography beyond current recommendations. Cardiovascular Ultrasound 201614 2. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12947-015-0045-0)

    Article  Google Scholar 

  21. Kleijn SA, Aly MF, Terwee CB, van Rossum AC & Kamp O. Reliability of left ventricular volumes and function measurements using three-dimensional speckle tracking echocardiography. European Heart Journal Cardiovascular Imaging 201213 159–168. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ejechocard/jer174)

    Article  Google Scholar 

  22. Santoro C, Arpino G, Esposito R, Lembo M, Paciolla I, Cardalesi C, de Simone G, Trimarco B, De Placido S & Galderisi M. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancer patients: a balance with feasibility. European Heart Journal Cardiovascular Imaging 201718 930–936. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ehjci/jex033)

    Article  Google Scholar 

  23. Obokata M, Nagata Y, Wu VC, Kado Y, Kurabayashi M, Otsuji Y & Takeuchi M. Direct comparison of cardiac magnetic resonance feature tracking and 2D/3D echocardiography speckle tracking for evaluation of global left ventricular strain. European Heart Journal Cardiovascular Imaging 201617 525–532. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ehjci/jev227)

    Article  Google Scholar 

Download references

Funding

This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations

  1. Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan

    Yasufumi Nagata MD, Kado Yuichiro MD, Onoue Takeshi MD, Otani Kyoko MD & Takeuchi Masaaki MD

  2. Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan

    Nakazono Akemi RDCS & Otsuji Yutaka MD

Authors
  1. Yasufumi Nagata MD
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Kado Yuichiro MD
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Onoue Takeshi MD
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Otani Kyoko MD
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Nakazono Akemi RDCS
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Otsuji Yutaka MD
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Takeuchi Masaaki MD
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Yasufumi Nagata MD.

Rights and permissions

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 InternationalLicense.(http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nagata, Y., Yuichiro, K., Takeshi, O. et al. Impact of image quality on reliability of the measurements of left ventricular systolic function and global longitudinal strain in 2D echocardiography. Echo Res Pract 5, 28–39 (2018). https://doiorg.publicaciones.saludcastillayleon.es/10.1530/ERP-17-0047

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1530/ERP-17-0047

Key Words

Echo Research & Practice

ISSN: 2055-0464

Contact us