1 research outputs found
Impact of apical foreshortening on deformation measurements: A report from the EACVI-ASE Strain Standardization Task Force
Aims Foreshortening of apical views is a common problem in
echocardiography. It results in an abnormally thick false apex and a
shortened left ventricular (LV) long axis. We sought to evaluate the
impact of foreshortened (FS) on LV ejection fraction (LVEF) and
layer-specific 2D speckle tracking based segmental (S) and global (G)
longitudinal strain (LS) measurements.
Methods and results We examined 72 participants using a GE Vivid E9
system. FS apical views were collected from an imaging window one
rib-space higher than the optimal images. Ejection fraction as well as
layer-specific GLS and SLS measurements were analysed by GE EchoPAC v201
and TomTec Image Arena 4.6 and compared between optimal and FS images.
On average, LV long axis was 10\% shorter in FS images than in optimal
images. FS induced a relative change in LVEF of 3.3\% and 6.9\% for GE
and TomTec, respectively (both, P < 0.001). Endocardial GLS was 9.0\%
higher with GE and 23.2\% with TomTec (P < 0.001). Midwall GLS
measurements were less affected (7.8\% for GE and 14.1\% for TomTec,
respectively, both P< 0.001). Segmental strain analysis revealed that
the mid-ventricular and apical segments were more affected by
foreshortening, and endocardial measurements were more affected than
midwall.
Conclusion Optimal image geometry is crucial for accurate LV function
assessment. Foreshorhening of apical views has a substantial impact on
longitudinal strain measurements, predominantly in the apex and in the
endocardial layer. Our data suggest that measuring midwall strain might
therefore be the more robust approach for clinical routine use