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Inter-vendor comparison of left atrial strain using layer specific strain analysis

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Abstract

Left atrial strain (LAS) on transthoracic echocardiogram (TTE) is increasingly recognised to have clinical utility in cardiovascular disease. Differences in LAS measurements between vendors remains a barrier for clinical use. We sought to compare LAS between two commonly used software platforms; the layer-specific endocardial and mid-myocardial measurements of LAS on General Electric (GE) Echopac were compared to TomTec strain. LAS was measured in 88 individuals with no previous cardiac history and 40 paroxysmal AF (PAF) patients, in sinus rhythm at TTE. Conventionally, LAS measured using GE Echopac is mid-myocardial strain (GE-mid); additionally, endocardial (GE-endo) LAS was evaluated. Both LAS measurements by GE were compared to TomTec-Arena (v2.30.02) measurements. Reservoir (ƐR), contractile (ƐCT) and conduit (ƐCD) phasic strain were evaluated. Both GE-mid and GE-endo LAS correlated well with TomTec LAS. On Bland–Altman analysis, GE-mid LAS measurements were systematically lower than TomTec LAS (ƐR: mean difference (MD) − 6.08%, limits of agreement (LOA) − 12%, 0%, ƐCT: MD − 0.8%, LOA − 7%, 5%, ƐCD: MD − 5.2% LOA − 12%, 1%). GE-endo LAS demonstrated no systematic difference from TomTec LAS, but had wider limits of agreement (ƐR: MD 0.41%, LOA − 7%, 8%, ƐCT: MD 0.50%, LOA − 6%, 7%, ƐCD: MD − 0.08%, LOA − 7%, 7%). ƐR had the best reproducibility. Mid-myocardial LAS, routinely evaluated by GE Echopac software, systematically underestimates LAS compared to TomTec. Using GE endocardial LAS eliminated this bias, but introduced greater variation between measurements. Serial measurements of LAS should therefore be performed on the same vendor system.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Abbreviations

2D:

Two-dimensional

AF:

Atrial fibrillation

ASE:

American Society of Echocardiography

BMI:

Body mass index

BSA:

Body surface area

CPA:

Cardiac performance arena

CV:

Coefficient of variation

ƐCD:

Left atrial conduit strain

ƐCT:

Left atrial contractile strain

ƐR:

Left atrial reservoir strain

EACVI:

European Association of Cardiovascular Imaging

Endo:

Endocardial

GE:

General electric

LA:

Left atrial

LAEF:

Left atrial emptying fraction

LAFI:

Left atrial function index

LAS:

Left atrial strain

LAVmax:

Left atrial maximum volume

LAVmin:

Left atrial minimum volume

LVEDV:

Left ventricular end diastolic volume

LVEF:

Left ventricular ejection fraction

Mid:

Mid-myocardial

MD:

Mean difference

PAF:

Paroxysmal atrial fibrillation group

SR:

Sinus rhythm

TTE:

Transthoracic echocardiography

References

  1. Trivedi SJ, Altman M, Stanton T, Thomas L (2019) Echocardiographic strain in clinical practice. Heart Lung Circul 28:1320

    Article  Google Scholar 

  2. Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI (2012) Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS2 scores. J Am Soc Echocardiogr 25(12):1327–1332

    Article  Google Scholar 

  3. Cameli M, Mandoli GE, Loiacono F, Sparla S, Iardino E, Mondillo S (2016) Left atrial strain: a useful index in atrial fibrillation. Int J Cardiol. 220(Supplement C):208–213

    Article  Google Scholar 

  4. Kim D, Shim CY, Cho IJ, Kim YD, Nam HS, Chang HJ et al (2016) Incremental value of left atrial global longitudinal strain for prediction of post stroke atrial fibrillation in patients with acute ischemic stroke. J Cardiovasc Ultrasound 24(1):20–27

    Article  Google Scholar 

  5. Olsen FJ, Jorgensen PG, Mogelvang R, Jensen JS, Fritz-Hansen T, Bech J et al (2016) Predicting paroxysmal atrial fibrillation in cerebrovascular ischemia using tissue doppler imaging and speckle tracking echocardiography. J Stroke Cerebrovasc Dis 25(2):350–359

    Article  Google Scholar 

  6. Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP (2019) Left atrial structure and function, and left ventricular diastolic dysfunction. J Am Coll Cardiol 73(15):1961

    Article  Google Scholar 

  7. Jarasunas J, Aidietis A, Aidietiene S (2018) Left atrial strain - an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc Ultrasound 16(1):29

    Article  Google Scholar 

  8. Park J-H, Hwang I-C, Park JJ, Park J-B, Cho G-Y (2020) Prognostic power of left atrial strain in patients with acute heart failure. Eur Heart J. https://doi.org/10.1093/ehjci/jeaa013

    Article  PubMed  Google Scholar 

  9. Gan GCH, Ferkh A, Boyd A, Thomas L (2018) Left atrial function: evaluation by strain analysis. Cardiovasc Diagn Ther 8(1):29–46

    Article  Google Scholar 

  10. Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M et al (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7(1):6

    Article  Google Scholar 

  11. Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt J-U (2015) Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE Inter-Vendor Comparison Study. J Am Soc Echocardiogr 28(10):1171–81.e2

    Article  Google Scholar 

  12. Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T et al (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J 19(6):591–600

    Google Scholar 

  13. Thomas JD, Badano LP (2013) EACVI-ASE-industry initiative to standardize deformation imaging: a brief update from the co-chairs. Eur Heart J 14(11):1039–1040

    Google Scholar 

  14. Voigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R et al (2014) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J 16(1):1–11

    Article  CAS  Google Scholar 

  15. Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K (2017) Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr 30(1):59-70.e8

    Article  Google Scholar 

  16. Pathan F, Zainal Abidin HA, Vo QH, Zhou H, D’Angelo T, Elen E et al (2019) Left atrial strain: a multi-modality, multi-vendor comparison study. Eur Heart J. https://doi.org/10.1093/ehjci/jez303

    Article  Google Scholar 

  17. Wang Y, Li Z, Fei H, Yu Y, Ren S, Lin Q et al (2019) Left atrial strain reproducibility using vendor-dependent and vendor-independent software. Cardiovasc Ultrasound 17(1):9

    Article  Google Scholar 

  18. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1-39.e14

    Article  Google Scholar 

  19. Thomas L, Hoy M, Byth K, Schiller NB (2008) The left atrial function index: a rhythm independent marker of atrial function. Eur J Echocardiogr 9(3):356–362

    PubMed  Google Scholar 

  20. Giavarina D (2015) Understanding Bland Altman analysis. Biochem Med (Zagreb) 25(2):141–151

    Article  Google Scholar 

  21. Negishi K, Lucas S, Negishi T, Hamilton J, Marwick TH (2013) What is the primary source of discordance in strain measurement between vendors: imaging or analysis? Ultrasound Med Biol 39(4):714–720

    Article  Google Scholar 

  22. Amzulescu MS, De Craene M, Langet H, Pasquet A, Vancraeynest D, Pouleur AC et al (2019) Myocardial strain imaging: review of general principles, validation, and sources of discrepancies. Eur Heart J 20(6):605–619

    CAS  Google Scholar 

  23. Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63(6):493–505

    Article  Google Scholar 

  24. Modin D, Biering-Sørensen SR, Møgelvang R, Alhakak AS, Jensen JS, Biering-Sørensen T (2018) Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J 20(7):804–815

    Google Scholar 

  25. 2D Cardiac Performance Analysis. Unterschleissheim, Germany: TOMTEC Imaging Systems GmbH

  26. Mouselimis D, Tsarouchas AS, Pagourelias ED, Bakogiannis C, Theofilogiannakos EK, Loutradis C et al (2020) Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis. Hell J Cardiol. https://doi.org/10.1016/j.hjc.2020.04.008

    Article  Google Scholar 

  27. Ünlü S, Mirea O, Duchenne J, Pagourelias ED, Bézy S, Thomas JD et al (2018) Comparison of feasibility, accuracy, and reproducibility of layer-specific global longitudinal strain measurements among five different vendors: a report from the EACVI-ASE strain standardization task force. J Am Soc Echocardiogr 31(3):374–80.e1

    Article  Google Scholar 

  28. Ramlogan S, Aly D, France R, Schmidt S, Hinzman J, Sherman A et al (2020) Reproducibility and intervendor agreement of left ventricular global systolic strain in children using a layer-specific analysis. J Am Soc Echocardiogr 33(1):110–119

    Article  Google Scholar 

  29. Risum N, Ali S, Olsen NT, Jons C, Khouri MG, Lauridsen TK et al (2012) Variability of global left ventricular deformation analysis using vendor dependent and independent two-dimensional speckle-tracking software in adults. J Am Soc Echocardiogr 25(11):1195–1203

    Article  Google Scholar 

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Liza Thomas

    Present address: Cardiology Department, Westmead Hospital, Corner Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia

Authors and Affiliations

  1. Westmead Clinical School, University of Sydney, Sydney, NSW, Australia

    Aaisha Ferkh, Siddharth J. Trivedi, Karen Byth & Liza Thomas

  2. Cardiology Department, Westmead Hospital, Westmead, Australia

    Aaisha Ferkh, Luke Stefani, Siddharth J. Trivedi, Paula Brown & Liza Thomas

  3. Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia

    Aaisha Ferkh, Luke Stefani, Siddharth J. Trivedi, Paula Brown, Karen Byth, Faraz Pathan & Liza Thomas

  4. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia

    Karen Byth

  5. Charles Perkins Centre, University of Sydney ,University of Sydney, Nepean Clinical School, Sydney, NSW, Australia

    Faraz Pathan

  6. Cardiology Department, Nepean Hospital, Sydney, Australia

    Faraz Pathan

  7. South Western Clinical School, University of New South Wales, Sydney, Sydney, Australia

    Liza Thomas

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  1. Aaisha Ferkh
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All authors have contributed to the design, data collection, analysis and manuscript preparation.

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Correspondence to Liza Thomas.

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The study ethics approval was obtained from the Human Research Ethics Committee of Western Sydney Local Health District (HREC/17/WMEAD/435).

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Ferkh, A., Stefani, L., Trivedi, S.J. et al. Inter-vendor comparison of left atrial strain using layer specific strain analysis. Int J Cardiovasc Imaging 37, 1279–1288 (2021). https://doi.org/10.1007/s10554-020-02114-x

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  • DOI: https://doi.org/10.1007/s10554-020-02114-x

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