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Inter-observer and Inter-vendor Variability in Strain Measurements in Patients with Single Right Ventricular Anatomy

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Abstract

Myocardial strain offers new insights into ventricular performance, There are software packages from several different companies used to ascertain this, and little data is available in patients with single right ventricle (sRV) physiology. We aimed to compare the analysis of two strain software applications using a cohort of patients with sRV for both inter-vendor and inter-observer variability. Echocardiograms from 85 patients with sRV (122 separate studies) were prospectively evaluated. All had Glenn and/or Fontan palliation. Longitudinal 4-chamber (4LS), inflow/outflow (IO), circumferential, and radial strain were assessed using Velocity Vector Imaging (VVI, Seimens, Munich) and Automated Functional Imaging (AFI, General Electric, Boston) software. In a subset of 45 patients (61 separate studies), strain measurements were obtained by two sonographers so a paired “inter-observer” analysis could be performed. A moderate correlation between measurements made by the two systems was observed. Circumferential strain assessment had the highest R value (0.77) with all others having R values < 0.6. Both software packages showed modest inter-observer reproducibility for longitudinal and circumferential strain. VVI intraclass correlation coefficients (ICC) for 4LS and average circumferential strain (ACS) were 0.6 and 0.58, compared to 0.68 and 0.59 for AFI. Other than radial strain and VVI IO inferior strain, mean strain differences between AFI and VVI were ≤ 1%. Inter-observer variability is modest, however, mean differences are minimal suggesting reasonable clinical reliability. Inter-vendor variability is greater and not as clinically reliable. In patients with sRV, serial assessments with strain should be performed using the same software.

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Data Availability

Data are available upon request.

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Acknowledgements

The authors acknowledge the statistical support provided by Megan M. O'Byrne, MA for this study. This study was possible by clinical and administrative support by Wanek Family Program for Hypoplastic Left Heart Syndrome Imaging Pipeline: Timothy J. Nelson, MD, PhD, Dawit T. Haile, MD, Karen S. Miller, CCRP, Lori A. Riess, CCRP, Karen M. Cavanaugh, CCRP, Lucas Timmons, CCRP. *Wanek Family Program for Hypoplastic Left Heart Syndrome Imaging Pipeline: Timothy J. Nelson, MD, PhD, Dawit T. Haile, MD, Karen S. Miller, CCRP, Lori A. Riess, CCRP, Karen M. Cavanaugh, CCRP, Lucas Timmons, CCRP.

Funding

This study was supported by the Todd and Karen Wanek Program for Hypoplastic Left Heart Syndrome, Mayo Clinic Foundation.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Alex J. Thompson, Patrick W. O’Leary, Benjamin W. Eidem & M. Yasir Qureshi

  2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Patrick W. O’Leary, Angela Miller, Sara Martineau, Chelsea Reece, Amanda Breuer, Benjamin W. Eidem & M. Yasir Qureshi

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  1. Alex J. Thompson
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Wanek Family Program for Hypoplastic Left Heart Syndrome Imaging Pipeline

  • Timothy J. Nelson
  • , Dawit T. Haile
  • , Karen S. Miller
  • , Lori A. Riess
  • , Karen M. Cavanaugh
  •  & Lucas Timmons

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Correspondence to M. Yasir Qureshi.

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The authors have no conflicts of interest to disclose.

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This study was approved by an institutional review board of Mayo Clinic.

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The Members of the study group Wanek Family Program for Hypoplastic Left Heart Syndrome Imaging Pipeline was present in Acknowledgements.

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Thompson, A.J., O’Leary, P.W., Miller, A. et al. Inter-observer and Inter-vendor Variability in Strain Measurements in Patients with Single Right Ventricular Anatomy. Pediatr Cardiol 42, 1341–1349 (2021). https://doi.org/10.1007/s00246-021-02617-x

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  • DOI: https://doi.org/10.1007/s00246-021-02617-x

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