Left Ventricular Global Strain Analysis by Two-Dimensional Speckle-Tracking Echocardiography: The Learning Curve

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Speckle-tracking echocardiography for left ventricular (LV) global strain is increasingly used.
• Lack of established guidelines for training requirements in LV strain analysis.
• Need to define learning curves and competency benchmarks for strain analysis.

Purpose of the Study:

• To determine the learning curve for LV global strain analysis.
• To establish the number of studies needed for independent reporting of strain analysis.
• To assess learning curves across different observer groups.

Main Methods:

• Novice observers (fellows, sonographers, students) underwent standardized training.
• Retrospective analysis of 100 patient studies over 3 months.
• Quartiles of 25 studies were analyzed successively and compared to expert consensus.

Main Results:

• Global longitudinal strain (GLS) demonstrated uniform learning curves, requiring 50 studies for expert competency (ICC > 0.9).
• Prior echocardiography knowledge impacted learning reproducibility and efficiency.
• Global circumferential and radial strain analyses did not achieve expert levels within the study period.

Conclusions:

• A significant learning curve exists for LV strain analysis.
• A minimum of 50 studies is recommended for achieving competency in GLS analysis.
• Standardized training and practice are crucial for accurate strain interpretation.