Measuring left ventricular global longitudinal strain in different contrast-enhanced echocardiography modes: a...

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Left ventricular global longitudinal strain (LVGLS) is a sensitive measure of left ventricular (LV) systolic function, surpassing traditional left ventricular ejection fraction (LVEF).
• The accuracy and reproducibility of LVGLS measurements using ultrasound enhancing agents (UEA) in contrast-enhanced echocardiography (CE) remain debated.
• This study aimed to assess the feasibility and reproducibility of LVGLS measurements across different CE modes.

Purpose of the Study:

• To evaluate the feasibility of measuring LVGLS using contrast-enhanced echocardiography (CE).
• To assess the reproducibility of LVGLS measurements in different CE modes (LVO and MCE) compared to standard 2D mode.
• To determine if CE can mitigate the impact of suboptimal image quality on LVGLS measurements.

Main Methods:

• Utilized two-dimensional speckle tracking echocardiography (2D-STE) to measure LVGLS in 75 patients.
• Categorized patients into optimal (n=33) and suboptimal (n=42) acoustic window groups.
• Compared LVGLS measurements across 2D mode, left ventricular opacification (LVO) mode, and myocardial contrast echocardiography (MCE) mode, analyzing agreement using Bland-Altman, linear regression, and ICC.

Main Results:

• In the optimal group, LVO and MCE modes showed comparable LVGLS values to 2D mode (ICC: 0.814 for 2D-LVO, 0.781 for 2D-MCE).
• Good agreement was observed between LVO and MCE modes across both groups (ICC: 0.855 optimal, 0.935 suboptimal).
• In the suboptimal group, LVO and MCE modes demonstrated poorer agreement with 2D mode (ICC: 0.739 for 2D-LVO, 0.687 for 2D-MCE), but CE significantly improved inter-observer variability (ICC: 0.864 LVO, 0.830 MCE).

Conclusions:

• LVGLS can be reliably measured using different CE modes, including in patients with suboptimal acoustic windows.
• Contrast enhancement effectively reduces the impact of image quality on LVGLS measurements.
• CE echocardiography offers a feasible and reproducible method for assessing LV systolic function, especially when standard imaging is challenging.