Left ventricular ejection fraction and Global Longitudinal Strain variability between methodology and experience

Kouris, Nikos T.; Kostopoulos, V.; Psarrou, Georgia A.; Kostakou, Peggy; Tzavara, Chara; Olympios, Christoforos

doi:10.1111/echo.15025

Cited by 12 publications

(12 citation statements)

References 21 publications

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“…High reproducibility of vLVEF depends on reader experience and can hence not be generalized. 44 The results of FS and LVEF measurements were contradictory in Despite the limitations of cohort size and follow-up time, our results demonstrate a high feasibility of LS also in retrospective echocardiographic datasets. Our results indicate that LS entails higher sensitivity for detecting subclinical changes in cardiac function compared to FS and LVEF.…”

Section: Discussionmentioning

confidence: 60%

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Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience

Alpman,

Jarting,

Magnusson

et al. 2023

Cancer Reports

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BackgroundThe growing population of long‐term childhood cancer survivors encounter a substantial burden of cardiovascular complications. The highest risk of cardiovascular complications is associated with exposure to anthracyclines and chest radiation. Longitudinal cardiovascular surveillance is recommended for childhood cancer patients; however, the optimal methods and timing are yet to be elucidated.AimsWe aimed to investigate the feasibility of different echocardiographic methods to evaluate left ventricular systolic function in retrospective datasets, including left ventricular ejection fraction (LVEF), fractional shortening (FS), global longitudinal strain (GLS) and longitudinal strain (LS) as well as the incidence and timing of subclinical left ventricular dysfunction detected by these methods.Methods and ResultsA retrospective longitudinal study was performed with re‐analysis of longitudinal echocardiographic data, acquired during treatment and early follow‐up, including 41 pediatric sarcoma patients, aged 2.1–17.8 years at diagnosis, treated at Astrid Lindgren Children's Hospital, Stockholm, Sweden, during the period 2010–2021. All patients had received treatment according to protocols including high cumulative doxorubicin equivalent doses (≥250 mg/m2). In 68% of all 366 echocardiograms, LS analysis was feasible. Impaired LS values (<17%) was demonstrated in >40%, with concomitant impairment of either LVEF or FS in 20% and combined impairment of both LVEF and FS in <10%. Importantly, there were no cases of abnormal LVEF and FS without concomitant LS impairment.ConclusionOur findings demonstrate feasibility of LS in a majority of echocardiograms and a high incidence of impaired LS during anthracycline treatment for childhood sarcoma. We propose inclusion of LS in pediatric echocardiographic surveillance protocols.

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Section: Discussionmentioning

confidence: 60%

“…Visual LVEF was on the other hand assessable in 95% (347/366) of all echocardiograms. High reproducibility of vLVEF depends on reader experience and can hence not be generalized 44 . The results of FS and LVEF measurements were contradictory in 35/366 echocardiograms, which might pose a problem in clinical decision‐making.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience

Alpman,

Jarting,

Magnusson

et al. 2023

Cancer Reports

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“…EF is the cornerstone of assessment of left ventricular (LV) systolic function. 11 Calculating LV volumes and EF from 2D images by using the biplane method of modified Simpson's rule is considered more accurate and better reproducible. However, because of the geometric assumptions of this 2D method, measurements may be inaccurate if the shape of the left ventricle is abnormal or when the acquisition of the 2D images is suboptimal.…”

Section: Discussionmentioning

confidence: 99%

“…EF is the cornerstone of assessment of left ventricular (LV) systolic function 11 . Calculating LV volumes and EF from 2D images by using the biplane method of modified Simpson's rule is considered more accurate and better reproducible.…”

Section: Discussionmentioning

confidence: 99%

Assessment of left ventricular function by spatio‐temporal image correlation in fetuses with fetal growth restriction

Ziyu

2022

Echocardiography

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Aim To compare the evaluation of left ventricular function by spatio‐temporal image correlation (STIC) between fetal growth restriction (FGR) fetuses and normal fetuses. Methods Forty‐two FGR fetuses and 50 normal fetuses with gestational age ranging from 28 to 35 weeks, were chosen for the study group and control group, respectively. The fetal heart was acquired using the STIC modality, beginning with a four‐chamber view. A 7.5–12.5 s acquisition time and 20–35°angle of the acquisition were used for the acquisition. The resulting STIC dataset was saved for offline analysis. Ventricular volumes were measured using the Virtual Organ Computer‐aided Analysis (VOCAL) mode, where the observer defines the contours of the ventricle and traces the endocardia. Stroke volume (SV) = end diastolic volume (EDV)−end systolic volume (ESV) and ejection fraction (EF) = SV/EDV × 100%. The data of the two groups were analyzed. Results (1) SV increased with fetal growth in both groups and was positively correlated with gestational age (p < .01), whereas EF remained constant throughout gestation and had no correlation with gestational age (p > .05). (2) There was no difference found in EF between the two groups, (p > .05), SV was significantly lower in FGR group than those in the normal group (p < .01). Conclusion The STIC is a precise method for calculating fetal ventricular volume changes and functions. Reduced SV occurred at the initial stage of fetal deterioration before the discovery of abnormal EF in FGR fetuses, indicating cardiac dysfunction. SV could be a sensitive indicator of cardiac dysfunction. The use of EF to assess fetal cardiac function is not perfect.

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“…Different apical views (typically 4-chamber, 2-chamber, and apical long axis views) are obtained by different placements of the ultrasound probe relative to the heart apex [ 1 ]. The estimation process is usually laborious and time-consuming, especially when considering medical emergencies, while accuracy depends on the cardiologist’s experience in ECHO and the quality of scans [ 6 ], leading to considerable measurement variability [ 4 , 7 ]. Improving measurement precision and reliability is necessary, as it has been shown that EF and GLS values and their impairments are closely connected to patients’ prognosis and course [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Validation of an Artificial Intelligence–Based Tool for Automatic Estimation of Left Ventricular Ejection Fraction and Strain in Echocardiography: Protocol for a Two-Phase Prospective Cohort Study

Hadjidimitriou¹,

Pagourelias²,

Apostolidis³

et al. 2023

JMIR Res Protoc

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Background Echocardiography (ECHO) is a type of ultrasonographic procedure for examining the cardiac function and morphology, with functional parameters of the left ventricle (LV), such as the ejection fraction (EF) and global longitudinal strain (GLS), being important indicators. Estimation of LV-EF and LV-GLS is performed either manually or semiautomatically by cardiologists and requires a nonnegligible amount of time, while estimation accuracy depends on scan quality and the clinician’s experience in ECHO, leading to considerable measurement variability. Objective The aim of this study is to externally validate the clinical performance of a trained artificial intelligence (AI)–based tool that automatically estimates LV-EF and LV-GLS from transthoracic ECHO scans and to produce preliminary evidence regarding its utility. Methods This is a prospective cohort study conducted in 2 phases. ECHO scans will be collected from 120 participants referred for ECHO examination based on routine clinical practice in the Hippokration General Hospital, Thessaloniki, Greece. During the first phase, 60 scans will be processed by 15 cardiologists of different experience levels and the AI-based tool to determine whether the latter is noninferior in LV-EF and LV-GLS estimation accuracy (primary outcomes) compared to cardiologists. Secondary outcomes include the time required for estimation and Bland-Altman plots and intraclass correlation coefficients to assess measurement reliability for both the AI and cardiologists. In the second phase, the rest of the scans will be examined by the same cardiologists with and without the AI-based tool to primarily evaluate whether the combination of the cardiologist and the tool is superior in terms of correctness of LV function diagnosis (normal or abnormal) to the cardiologist’s routine examination practice, accounting for the cardiologist’s level of ECHO experience. Secondary outcomes include time to diagnosis and the system usability scale score. Reference LV-EF and LV-GLS measurements and LV function diagnoses will be provided by a panel of 3 expert cardiologists. Results Recruitment started in September 2022, and data collection is ongoing. The results of the first phase are expected to be available by summer 2023, while the study will conclude in May 2024, with the end of the second phase. Conclusions This study will provide external evidence regarding the clinical performance and utility of the AI-based tool based on prospectively collected ECHO scans in the routine clinical setting, thus reflecting real-world clinical scenarios. The study protocol may be useful to investigators conducting similar research. International Registered Report Identifier (IRRID) DERR1-10.2196/44650

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Left ventricular ejection fraction and Global Longitudinal Strain variability between methodology and experience

Cited by 12 publications

References 21 publications

Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience

Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience

Assessment of left ventricular function by spatio‐temporal image correlation in fetuses with fetal growth restriction

Clinical Validation of an Artificial Intelligence–Based Tool for Automatic Estimation of Left Ventricular Ejection Fraction and Strain in Echocardiography: Protocol for a Two-Phase Prospective Cohort Study

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