4 research outputs found
Left ventricular ejection fraction and Global Longitudinal Strain variability between methodology and experience
Introduction Although ejection fraction (EF) is the cornerstone of the
assessment of left ventricular (LV) systolic function, its measurement
faces a number of challenges related to image quality, assumptions of LV
geometry, and expertise. The aim of this study was to test the
inter-observer variability of EF and GLS measurement in patients with a
broad spectrum of LV function, between physicians and investigators
(Inv) with different levels of expertise.
Methods In 122 patients, EF and GLS were measured by 4 Inv blinded to
each other with different level of experience in echocardiography; EF
was measured using 3 methods: visual assessment, biplane Simpson's
method, and auto-EF method. GLS was measured from the 3 apical views. A
significant difference for LVEF and for LVGLS was considered to be >10
and >2 absolute values, respectively.
Results Intra-observer agreement was excellent for visually assessed EF
(ICC = 0.87, P < .001) and GLS (ICC = 0.82, P < .001) and good for EF
measured by Simpson's method (ICC = 0.70, P < .001) and auto-EF (ICC =
0.72, P < .001). Intra-observer and inter-observer agreements were
excellent for GLS with ICCs above 0.8. GLS discordance between the 4 Inv
was not significant. Discordance in EF and GLS measurements among the
Inv was not related to image quality or wall motion abnormalities.
Conclusion Although EF has proved its prognostic value in various
cardiovascular entities, GLS seems to be more reliable for serial
assessment of LV function, demonstrating lower intra- and inter-observer
variability, even by different physicians with variant level of
expertise