title: Reproducibility of regional and global longitudinal strains derived from two-dimensional speckle-tracking and doppler tissue imaging between expert and novice readers during quantitative dobutamine stress echocardiography.
abstract: BACKGROUND
  Longitudinal strain (LS) is a quantitative parameter that adds incremental value to wall motion analysis. The aim of this study was to compare the reproducibility of LS derived from Doppler tissue imaging and speckle-tracking between an expert and a novice strain reader during dobutamine stress echocardiography (DSE).
  
  
  METHODS
  Forty-one patients (mean age, 65 ± 15 years; mean ejection fraction, 58 ± 11%) underwent DSE per clinical protocol. Global LS derived from speckle-tracking and regional LS derived from both speckle-tracking and Doppler tissue imaging were measured twice by an expert strain reader and also measured twice by a novice strain reader. Intraobserver and interobserver analyses were performed using intraclass correlation coefficients (ICC), Bland-Altman analysis, and absolute difference values (mean ± SD).
  
  
  RESULTS
  Global LS measured by the expert strain reader demonstrated high intraobserver measurement reproducibility (rest: ICC = 0.95, absolute difference = 5.5 ± 4.9%; low dose: ICC = 0.96, absolute difference = 5.7 ± 3.7%; peak dose: ICC = 0.87, absolute difference = 11.4 ± 8.4%). Global LS measured by the novice strain reader also demonstrated high intraobserver reproducibility (rest: ICC = 0.97, absolute difference = 4.1 ± 3.4%; low dose: ICC = 0.94, absolute difference = 5.4 ± 5.9%; peak dose: ICC = 0.94, absolute difference = 6.1 ± 4.8%). Global LS also showed high interobserver agreement between the expert and novice readers at all stages of DSE (rest: ICC = 0.90, absolute difference = 8.5 ± 7.5%; low dose: ICC = 0.90, absolute difference = 8.9 ± 7.1%; peak dose: ICC = 0.87, absolute difference = 10.8 ± 8.4%). Of all parameters studied, LS derived from Doppler tissue imaging had relatively low interobserver and intraobserver agreement.
  
  
  CONCLUSIONS
  Global LS is highly reproducible during all stages of DSE. This variable is a potentially reliable and reproducible measure of myocardial deformation.
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia; Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Australia.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia.
authors.forename: Sushil A
authors.initials: SA
authors.lastname: Luis
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sathianathan
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Khandheria
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Cafaro
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Hamilton-Craig
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Platts
authors.affiliation: Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Haseler
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia.
authors.forename: Darryl
authors.initials: D
authors.lastname: Burstow
authors.affiliation: Department of Cardiology, The Prince Charles Hospital, Heart and Lung Institute, Queensland Health, Brisbane, Australia; Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Australia. Electronic address: jonathan.chan@griffith.edu.au.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chan
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005961:Glucosinolates; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D005961:Glucosinolates; C009048:progoitrin
keywords: Dobutamine stress echocardiography; Doppler tissue imaging; Global longitudinal strain; Regional longitudinal strain; Speckle-tracking