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Abstract

Background: Left ventricular global longitudinal strain (GLS) with cardiovascular magnetic resonance (CMR) is an important prognostic biomarker. Its everyday clinical use is limited due to methodological and postprocessing diversity among the users and vendors. Standardization of postprocessing approaches may reduce the random operator-dependent variability, allowing for comparability of measurements despite the systematic vendor-related differences.Methods: We investigated the random component of variability in GLS measurements by optimization steps which incrementally improved observer reproducibility and agreement. Cine images in two-, three- and four-chamber-views were serially analysed by two independent observers using two different CMR-FT softwares. The disparity of outcomes after each series was systematically assessed after a number of stepwise adjustments which were shown to significantly reduce the inter-observer and intervendor bias, resulting standardized postprocessing approach. The final analysis was performed in 44 subjects (ischaemic heart disease n = 15, non-ischaemic dilated cardiomyopathy, n = 19, healthy controls, n = 10). All measurements were performed blind to the underlying group allocation and previous measurements. Inter- and intra-observer variability were tested using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CVs).Results: Compared to controls, mean GLS was significantly lower in patients, as well as between the two subgroups (p Conclusion: Standardization of GLS postprocessing helps to reduce the random component of variability, introduced by inconsistencies of and between observers, and also intervendor variability, but not the systematic inter-vendor bias due to differences in image processing algorithms. Standardization of GLS measurements is an essential step in ensuring the reliable quantification of myocardial deformation, and implementation of CMR-FT in clinical routine.

Item Type:	Article
Authors/Creators:	Heinke, R and Pathan, F and Le, M and D'Angelo, T and Winau, L and Arendt, C and Vogl, TJ and Zeiher, A and Nagel, E and Puntmann, VO
Keywords:	cardiac magnetic resonance, feature tracking, longitudinal strain, myocardial deformation, standardization
Journal or Publication Title:	BMC Cardiovascular Disorders
Publisher:	BioMed Central Ltd.
ISSN:	1471-2261
DOI / ID Number:	https://doi.org/10.1186/s12872-019-1255-4
Copyright Information:	Copyright 2019 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/
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