Feasibility and Reproducibility of Systolic Right Ventricular Strain Measurement by Speckle-Tracking Echocardiography in Premature Infants

Philip Thaler Levy, Mark R. Holland, Timothy J. Sekarski, Aaron Hamvas, Gautam K. Singh
2013 Journal of the American Society of Echocardiography  
Background-Right ventricular (RV) systolic function is an important prognostic determinant of cardiopulmonary pathologies in premature infants. Measurements of dominant RV longitudinal deformation are likely to provide a sensitive measure of RV function. An approach for image acquisition and post-acquisition processing is needed for reliable and reproducible measurements of myocardial deformation by two-dimensional speckle-tracking echocardiographic (2DSTE). The aim of this study was to
more » ... e the feasibility and reproducibility of 2DSTE measurement of RV peak global longitudinal strain (pGLS) and systolic strain rate (pGLSr) in premature infants, and establish methods for acquiring and analyzing strain Methods-We designed the study in two phases: (i) a Training Phase to develop methods of image acquisition and post-processing in a cohort of 30 premature infants (born at 28 ± 1 weeks), and (ii) a Study Phase to prospectively test in a separate cohort of 50 premature infants (born at 27 ± 1 weeks) if the methods improved the feasibility and reproducibility of RV pGLS and pGLSr measurements to a clinically significant level assessed by Bland Altman analysis (bias, limits of agreement (LOA), coefficient of variation (CV), and intra-class correlation (ICC). Results-Strain imaging was feasible from 84% of the acquisitions using the methods developed for optimal speckle brightness and frame rate for RV-focused image acquisition. There was high intra-observer (bias 3%, 95% LOA −1.6 to +1.6; CV 2.7%; ICC 0.97, p=0.02) and inter-observer (bias 7%, 95% LOA −4.8 to +4.73; CV 3.9%; ICC 0.93; p<0.05) reproducibility, with excellent linear correlation between the two pGLS measurements (r=0.97, p<0.01 and r=0.93, p<0.05, respectively). Conclusion-This study demonstrates high clinical feasibility and reproducibility of RV pGLS and RV pGLSr measurements by 2DSTE in premature infants and offers methods for image acquisition and data analysis for systolic strain imaging that can provide a reliable assessment of global RV function.
doi:10.1016/j.echo.2013.06.005 pmid:23880052 pmcid:PMC3800696 fatcat:mwv2sdjl4bf4nkg3pqskjbypei