Test–retest reliability of new and conventional echocardiographic parameters of left ventricular systolic function

• Published in: Clinical research in cardiology Vol. 108; no. 4; pp. 355 - 365
• Main Authors: Baron, Tomasz, Berglund, Lars, Hedin, Eva-Maria, Flachskampf, Frank A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2019; Springer Nature B.V
• Subjects: Cardiology; Change detection; Correlation coefficients; Ejection fraction; Global longitudinal strain; Heart; Kardiologi; Left ventricular function; Mathematical analysis; Medicine; Medicine & Public Health; Mitral annulus plane systolic excursion; Original Paper; Parameters; Reliability analysis; Reliability aspects; Test–retest reliability; Ventricle; Mitral annulus plane systolic excursion; Test–retest reliability; Global longitudinal strain; Left ventricular function; Ejection fraction
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-018-1363-7

Background Reliability of left ventricular function measurements depends on actual biological conditions, repeated registrations and their analyses. Objective To investigate test–retest reliability of speckle-tracking-derived strain measurements and its determinants compared to the conventional parameters, such as ejection fraction (EF), LV volumes and mitral annular plane systolic excursion (MAPSE). Methods In 30 patients with a wide range of left ventricular function (mean EF 46.4 ± 16.4%, range 14–73%), standard echo views were acquired independently in a blinded fashion by two different echocardiographers in immediate sequence and analyzed off-line by two independent readers, creating 4 data sets per patient. Test–retest reliability of studied parameters was calculated using the smallest detectable change (SDC) and a total, inter-acquisition and inter-reader intra-class correlation coefficient (ICC). Results The smallest detectable change normalized to the mean absolute value of the measured parameter (SDCrel) was lowest for MAPSE (10.7%). SDCrel for EF was similar to GLS (14.2 and 14.7%, respectively), while SDCrel for CS was much higher (35.6%). The intra-class correlation coefficient was excellent (> 0.9) for all measures of the left ventricular function. Intra-patient inter-acquisition reliability (ICCacq) was significantly better than inter-reader reliability (ICCread) (0.984 vs. 0.950, p  = 0.03) only for EF, while no significant difference was observed for any other LV function parameter. Mean intra-subject standard deviations were significantly correlated to the mean values for CS and LV volumes, but not for the other studied parameters. Conclusions In a test–retest setting, both with normal and impaired left ventricular function, the smallest relative detectable change of EF, GLS and MAPSE was similar (11–15%), but was much higher for CS (35%). Surprisingly, reliability of GLS was not superior to that of EF. Acquisition and reader to a similar extent influenced the reliability of measurements of all left ventricular function measures except for ejection fraction, where the reliability was more dependent on the reader than on the acquisition.