Feasibility, repeatability, and reproducibility of contemporary diastolic parameters and classification.

PURPOSE: To evaluate feasibility, time of acquisition, retest repeatability and reproducibility of echocardiographic indexes and classification algorithms of diastolic function. METHODS: A total of 356 patients were examined before coronary artery bypass-grafting and/or aortic valve surgery. A subgroup of 50 was examined with 3 successive echocardiograms in conditions reflecting daily clinical practice. Diastolic parameters were obtained and analysed according to previous (2009) and current (2016) guidelines. Acquisition and analysis time, plus intra- and inter-observer variability were assessed. RESULTS: Feasibility of diastolic parameters was between 93 and 99%, except the maximal tricuspid regurgitation velocity (TR Vmax) (65%). Mean acquisition and analysis time were highest for left atrial volumes (141 ± 24 s) in contrast to other parameters which were obtained in approximately one minute. Mean 368 and 360 s were needed to classify diastolic function according to the 2009 and 2016 algorithms, respectively (non-significant). Reproducibility was overall moderate (Pearson r = 0.62 to 0.87), with TR Vmax having the highest (r = 0.62) and mitral valve E/A ratio the lowest (r = 0.87) variation. The 2009 algorithm resulted in more indeterminate cases than the 2016 algorithm. Inter-examiner analysis resulted in reclassification of 20 vs. 8 patients using the 2009 and 2016 algorithms, respectively. CONCLUSION: Diastolic parameters are highly feasible and moderately reproducible, except TR Vmax. The 2016 algorithm is more restrictive than the 2009 algorithm in classifying patients with advanced stages of diastolic dysfunction. Time of acquisition according to the two guidelines is not significantly different.

Global longitudinal strain before cardiac surgery: Improving feasibility, reproducibility, and variability.

BACKGROUND: Global longitudinal strain (GLS) is a predictor of outcome after cardiac surgery. If integrated into clinical decision-making and timing of surgery, it is important to evaluate the feasibility, reproducibility, and variation of GLS in this selection of patients, where poor image quality and nontraceable segments are frequent. METHODS AND RESULTS: Two-dimensional strain analysis was performed on 250 patients planned to undergo open-heart surgery. Intra- and inter-examiner retest variability was assessed in 50 consecutive patients. All myocardial segments were traceable in 119 patients, and GLS of those served as a reference in comparison with alternative strain models with nontraceable segments. Global longitudinal strain estimation by the recommended method of a maximum of one nontraceable segment per view was only feasible in 64% of cases (mean GLS -16%). Reproducibility was moderate (intra-observer coefficient of variation [CV] 8%; inter-observer CV 10%) and variation of GLS showed bias ± 95% limits of agreement (LOA) of 0.6 ± 1.1 (P < .05). Accepting three nontraceable segments in total increased feasibility to 77% with similar reproducibility (intra-observer CV 8%; inter-observer CV 11%) and variation (bias ± LOA: 0.6 ± 1.3, P < .05). A model with a maximum of one apical, one mid, and one basal nontraceable segment increased feasibility to 72% with similar reproducibility (intra-observer CV 8%; inter-observer CV 10%) and variation (bias ± LOA: 0.4 ± 1.2, P < .05). CONCLUSION: Global longitudinal strain estimation in patients prior to cardiac surgery is challenged by moderate feasibility, retest variation as well as variation in cases of nontraceable segments. We suggest alternative strain models with improved feasibility without compromising reproducibility and variation.

Semi-automated estimation of left ventricular ejection fraction by two-dimensional and three-dimensional echocardiography is feasible, time-efficient, and reproducible.

PURPOSE: To compare two-dimensional (2D) and three-dimensional (3D) methods to estimate left ventricular ejection fraction (LVEF) with respect to feasibility, time consumption, and retest reproducibility. METHODS: A total of 100 patients planned to undergo coronary artery bypass grafting and/or aortic valve replacement were included consecutively. 2D and 3D echocardiography was performed on all patients. Acquisition and analysis time as well as intra- and inter-examiner variability were assessed in 50 consecutive patients with 3 repeated echocardiographic examinations and analyses. LVEF was estimated by five different methods: uniplane, biplane, and single-beat triplane (SB3P), as well as semi-automated biplane (AutoEF) and 3D volumetric tracings (4D Auto LVQ). All methods were compared to Simpson's biplane method and feasibility was determined. RESULTS: Feasibility of Simpson's uniplane method, Simpson's biplane method, AutoEF, SB3P, and 4D Auto LVQ was 97%, 92%, 86%, 70%, and 89%, respectively. All methods evaluated were 18%-33% faster (P < 0.001) than Simpson's biplane method (115 seconds, standard deviation 15 seconds). Compared to Simpson's biplane method mean LVEF was slightly underestimated by 4D Auto LVQ (-2 ± 8%, P = 0.02), but not significantly different when assessed by the other methods. AutoEF and 4D Auto LVQ showed the lowest test variability (intra-examiner coefficient of variation (CV) 10%-11%; inter-examiner CV 10%-12% vs intra-examiner CV 12%-18%; inter-examiner CV 12%-20%). CONCLUSIONS: Estimation of LVEF by modern semi-automated 2D and 3D echocardiographic modalities is feasible, time-efficient, and reproducible.