Daniel Forsha1, Niels Risum2, Sudarshan Rajagopal3, Stephen Dolgner4, Christoph Hornik5, Huiman Barnhart5, Joseph Kisslo3, Piers Barker6. 1. Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri. 2. Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark. 3. Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina. 4. Department of Pediatrics, Duke University Medical Center, Durham, North Carolina. 5. Department of Biostatistics and Bioinformatics and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. 6. Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina. Electronic address: piers.barker@duke.edu.
Abstract
BACKGROUND: Speckle-tracking strain is almost universally cited as being independent of angle of insonation, but there are minimal confirmatory studies, and this claim may not be consistent with the known limitations of ultrasound axial and lateral spatial resolution. The aim of this study was to assess the influence of angle and depth on longitudinal peak systolic strain (LPS). METHODS: Thirty-four healthy pediatric subjects (age range, 6-18 years; 47% male) with normal cardiac anatomy and good image quality were prospectively imaged. Angular comparisons of LPS were investigated by examining interangle reproducibility on the basis of one standard and one alternative image acquisition relative to intraobserver reproducibility of two standard views of the same left ventricular segments. A single-window comparison was used to evaluated septal LPS: standard apical four-chamber versus right ventricular centered four-chamber. Two paired standard and alternative window comparisons were as follows: (1) four-chamber: standard apical versus subcostal; and (2) three-chamber: standard apical versus parasternal long-axis. RESULTS: The global LPS intraobserver difference using the paired standard and alternative window comparisons was lower than the interangle difference in global LPS (-1.0 ± 0.1% vs -2.1 ± 2.4%). Intraobserver reproducibility was significantly higher than interangle reproducibility (intraclass correlation coefficient = 0.9 vs 0.29, P < .001). Similar results were found in the segmental strain analysis. Interangle reproducibility was significantly decreased compared with intraobserver reproducibility in the septal single-window comparison. Target depth assessment demonstrated a systematic bias between the near-field and far-field segments. CONCLUSIONS: Echocardiographically derived LPS values were modestly dependent on angle of insonation and target depth in this pediatric population. Normal strain ranges derived from standard apical images should not be applied to strain derived from sub-costal images, off-axis apical imaging, or applications in which a standard window cannot be defined.
BACKGROUND: Speckle-tracking strain is almost universally cited as being independent of angle of insonation, but there are minimal confirmatory studies, and this claim may not be consistent with the known limitations of ultrasound axial and lateral spatial resolution. The aim of this study was to assess the influence of angle and depth on longitudinal peak systolic strain (LPS). METHODS: Thirty-four healthy pediatric subjects (age range, 6-18 years; 47% male) with normal cardiac anatomy and good image quality were prospectively imaged. Angular comparisons of LPS were investigated by examining interangle reproducibility on the basis of one standard and one alternative image acquisition relative to intraobserver reproducibility of two standard views of the same left ventricular segments. A single-window comparison was used to evaluated septal LPS: standard apical four-chamber versus right ventricular centered four-chamber. Two paired standard and alternative window comparisons were as follows: (1) four-chamber: standard apical versus subcostal; and (2) three-chamber: standard apical versus parasternal long-axis. RESULTS: The global LPS intraobserver difference using the paired standard and alternative window comparisons was lower than the interangle difference in global LPS (-1.0 ± 0.1% vs -2.1 ± 2.4%). Intraobserver reproducibility was significantly higher than interangle reproducibility (intraclass correlation coefficient = 0.9 vs 0.29, P < .001). Similar results were found in the segmental strain analysis. Interangle reproducibility was significantly decreased compared with intraobserver reproducibility in the septal single-window comparison. Target depth assessment demonstrated a systematic bias between the near-field and far-field segments. CONCLUSIONS: Echocardiographically derived LPS values were modestly dependent on angle of insonation and target depth in this pediatric population. Normal strain ranges derived from standard apical images should not be applied to strain derived from sub-costal images, off-axis apical imaging, or applications in which a standard window cannot be defined.
Authors: David Steflik; Ryan J Butts; George H Baker; Varsha Bandisode; Andrew Savage; Andrew M Atz; Shahryar M Chowdhury Journal: Echocardiography Date: 2017-07-28 Impact factor: 1.724
Authors: Jian-Fang Ren; Shiquan Chen; David J Callans; Qiang Liu; Gregory Supple; David S Frankel; Pasquale Santangeli; Ruhong Jiang; David Lin; Matthew Hyman; Lu Yu; Michael Riley; Yaxun Sun; Zuwen Zhang; Chan Yu; Robert D Schaller; Sanjay Dixit; Bei Wang; Chenyang Jiang; Francis E Marchlinski Journal: J Atr Fibrillation Date: 2021-02-28
Authors: K Ozawa; M G Davey; Z Tian; M A Hornick; A Y Mejaddam; P E McGovern; A W Flake; J Rychik Journal: Ultrasound Obstet Gynecol Date: 2020-04 Impact factor: 7.299
Authors: Bálint Károly Lakatos; Mihály Ruppert; Márton Tokodi; Attila Oláh; Szilveszter Braun; Christian Karime; Zsuzsanna Ladányi; Alex Ali Sayour; Bálint András Barta; Béla Merkely; Tamás Radovits; Attila Kovács Journal: ESC Heart Fail Date: 2021-03-23
Authors: Márton Tokodi; Attila Oláh; Alexandra Fábián; Bálint Károly Lakatos; István Hizoh; Mihály Ruppert; Alex Ali Sayour; Bálint András Barta; Orsolya Kiss; Nóra Sydó; Emese Csulak; Zsuzsanna Ladányi; Béla Merkely; Attila Kovács; Tamás Radovits Journal: Eur Heart J Cardiovasc Imaging Date: 2022-01-24 Impact factor: 6.875
Authors: F Gaborit; H Bosselmann; N Tønder; K Iversen; T Kümler; C Kistorp; G Sölétormos; J P Goetze; M Schou Journal: BMC Cardiovasc Disord Date: 2015-08-20 Impact factor: 2.298