Left atrial strain: A multi-modality, multi-vendor comparison study

• Published in: European Heart Journal Cardiovascular Imaging
• Main Author: Pathan F.; Zainal Abidin H.A.; Vo Q.H.; Zhou H.; D'Angelo T.; Elen E.; Negishi K.; Puntmann V.O.; Marwick T.H.; Nagel E.
• Format: Article
• Language: English
• Published: Oxford University Press 2021
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85099073355&doi=10.1093%2fehjci%2fjez303&partnerID=40&md5=1196ef3aab6425da1323eb7f139c1cd0

Aims: Left atrial (LA) strain is a prognostic biomarker with utility across a spectrum of acute and chronic cardiovascular pathologies. There are limited data on intervendor differences and no data on intermodality differences for LA strain. We sought to compare the intervendor and intermodality differences between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) derived LA strain. We hypothesized that various components of atrial strain would show good intervendor and intermodality correlation but that there would be systematic differences between vendors and modalities. Methods and results: We evaluated 54 subjects (43 patients with a clinical indication for CMR and 11 healthy volunteers) in a study comparing TTE- and CMR-derived LA reservoir strain (ϵR), conduit strain (ϵCD), and contractile strain (ϵCT). The LA strain components were evaluated using four dedicated types of post-processing software. We evaluated the correlation and systematic bias between modalities and within each modality. Intervendor and intermodality correlation was: ϵR [intraclass correlation coefficient (ICC 0.64-0.90)], ϵCD (ICC 0.62-0.89), and ϵCT (ICC 0.58-0.77). There was evidence of systematic bias between vendors and modalities with mean differences ranging from (3.1-12.2%) for ϵR, ϵCD (1.6-8.6%), and ϵCT (0.3-3.6%). Reproducibility analysis revealed intraobserver coefficient of variance (COV) of 6.5-14.6% and interobserver COV of 9.9-18.7%. Conclusion: Vendor derived ϵR, ϵCD, and ϵCT demonstrates modest to excellent intervendor and intermodality correlation depending on strain component examined. There are systematic differences in measurements depending on modality and vendor. These differences may be addressed by future studies, which, examine calibration of LA geometry/higher frame rate imaging, semi-quantitative approaches, and improvements in reproducibility. © 2019 Published on behalf of the European Society of Cardiology. All rights reserved.