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Regional Variability in Longitudinal Strain Across Vendors in Patients With Cardiomyopathy Due to Increased Left

Brett W Sperry1,2, Kimi Sato1, Dermot Phelan1

  • 1Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P).

Circulation. Cardiovascular Imaging
|August 16, 2019
PubMed

Insights

Vendor differences in longitudinal strain (LS) analysis impact diagnoses of cardiomyopathies. Global LS is correlated across vendors, but regional LS varies, affecting accuracy in cardiac amyloidosis, hypertrophic cardiomyopathy (HCM).

Area of Science:

  • Cardiology
  • Medical Imaging
  • Echocardiography

Background:

  • Cardiomyopathies with increased left ventricular wall thickness, including cardiac amyloidosis and hypertrophic cardiomyopathy (HCM), show distinct regional longitudinal strain (LS) patterns.
  • Previous studies have not evaluated the agreement of segmental and regional LS measurements across different vendors in these specific conditions.
  • This study addresses the need to assess vendor-specific LS values in cardiomyopathies with regional strain variations.

Purpose of the Study:

  • To assess the agreement of longitudinal strain (LS) values among different echocardiography vendors (GE, Siemens, Phillips) in patients with cardiac amyloidosis, septal HCM, and apical HCM.
  • To identify vendor-specific differences in segmental, regional, and global LS measurements.
  • To evaluate the impact of these vendor differences on the diagnostic performance for cardiac amyloidosis.

Main Methods:

  • A prospective, cross-sectional study involving 69 patients (18 amyloidosis, 30 septal HCM, 6 apical HCM, and 15 controls) undergoing outpatient echocardiography.
  • Peak systolic segmental, regional (basal, mid, apical), and global LS were analyzed using GE (EchoPAC), Siemens (Velocity Vector Imaging), and Phillips (QLab) software within the same imaging session.
  • Between-vendor agreement was assessed using correlation coefficients, Bland Altman plots, and mixed-effects modeling.

Main Results:

  • Global LS demonstrated high correlation across the three software packages and was significantly abnormal in patients with cardiac amyloidosis (P<0.001).
  • Regional LS analysis revealed that Phillips (QLab) software tended to yield more negative LS values, primarily due to differences in apical strain measurements.
  • GE (EchoPAC) software exhibited the highest diagnostic accuracy for identifying cardiac amyloidosis using regional strain values (AUC, 0.932) compared to Siemens and Phillips (P<0.001).

Conclusions:

  • Significant between-vendor variations exist in both global and regional longitudinal strain (LS) measurements for patients with cardiomyopathies characterized by increased left ventricular wall thickness.
  • Awareness of these vendor-specific differences is crucial for accurate diagnosis, prognosis assessment, and monitoring disease progression during serial echocardiographic examinations.
  • The findings highlight the importance of considering the echocardiography vendor and software used when interpreting LS in hypertrophic cardiomyopathy and cardiac amyloidosis.
Abstract

Keywords:
amyloidosisarea under the curvecardiomyopathiesechocardiographyprognosis

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