title: Comparison of septal strain patterns in dyssynchronous heart failure between speckle tracking echocardiography vendor systems.
abstract: OBJECTIVE
  To analyze inter-vendor differences of speckle tracking echocardiography (STE) in imaging cardiac deformation in patients with dyssynchronous heart failure.
  
  
  RESULTS
  Eleven patients (all with LBBB, median age 60.7 years, 9 males) with implanted cardiac resynchronization therapy devices were prospectively included. Ultrasound systems of two vendors (i.e. General Electric and Philips) were used to record images in the apical four chamber view. Regional longitudinal strain patterns were analyzed with vendor specific software in the basal, mid and apical septal segments. Systolic strain (SS), time to peak strain (TTP) and septal rebound stretch (SRS) were determined during four pacing settings, resulting in 44 unique strain patterns per segment (total 132 patterns). Cross correlation was used to analyze the comparability of the shape of 132 normalized strain patterns. Correlation of strain patterns of the two systems was high (R(2) median: 0.68, interquartile range: 0.53-0.82). Accordingly, strain patterns of intrinsic rhythm were recognized equally using both systems, when divided into three types. GE based SS (18.9 ± 4.7%) was significantly higher than SS determined by the Philips system (13.4 ± 4.3%). TTP was slightly but non-significantly lower in GE (384 ± 77 ms) compared to Philips (404 ± 83 ms) derived strain signals. Correlation of SRS between the systems was poor, due to minor differences in the strain signal and timing of aortic valve closure.
  
  
  CONCLUSIONS
  The two systems provide similar shape of strain patterns. However, important differences are found in the amplitude, timing of systole and SRS. Until STE is standardized, clinical decision making should be restricted to pattern analysis.
authors.affiliation: Department of Cardiology, University Medical Center Utrecht Utrecht, The Netherlands; Department of Physiology, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: w.m.vaneverdingen@umcutrecht.nl.
authors.forename: Wouter M
authors.initials: WM
authors.lastname: van Everdingen
authors.affiliation: Department of Physiology, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Paiman
authors.affiliation: Department of Physiology, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Caroline J M
authors.initials: CJ
authors.lastname: van Deursen
authors.affiliation: Department of Cardiology, University Medical Center Utrecht Utrecht, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Cramer
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: Vernooy
authors.affiliation: Department of Biomedical Engineering, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
authors.affiliation: Department of Physiology, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000295:instrumentation*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000295:instrumentation; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006346:Heart Septum / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: CRT; Correlation; Dyssynchrony; Heart failure; Longitudinal strain; SRS; Septum; Speckle tracking echocardiography; Strain patterns; Vendor comparison