Effect of Experience and Training on the Concordance and Precision of Strain Measurements

Abstract Objectives This study sought to show the degree to which experience and training affect the precision and validity of global longitudinal strain (GLS) measurement and to evaluate the variability of strain measurement after feedback. Background The application of GLS for the detection of sub...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging 2017-05, Vol.10 (5), p.518-522
Main Authors: Negishi, Tomoko, MD, Negishi, Kazuaki, MD, PhD, Thavendiranathan, Paaladinesh, MD, Cho, Goo-Yeong, MD, Popescu, Bogdan A., MD, PhD, Vinereanu, Dragos, MD, Kurosawa, Koji, MD, Penicka, Martin, MD, PhD, Marwick, Thomas H., MBBS, PhD, MPH
Format: Article
Language:English
Subjects:
Asia
Biomechanical Phenomena
Cardiovascular
Clinical Competence
concordance
Echocardiography - standards
Europe
experience
Formative Feedback
global longitudinal strain
Heart Diseases - diagnostic imaging
Heart Diseases - physiopathology
Humans
Inservice Training
Myocardial Contraction
North America
Observer Variation
Oceania
Predictive Value of Tests
Reproducibility of Results
Stress, Mechanical
Stroke Volume
Ventricular Function, Left
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Summary:Abstract Objectives This study sought to show the degree to which experience and training affect the precision and validity of global longitudinal strain (GLS) measurement and to evaluate the variability of strain measurement after feedback. Background The application of GLS for the detection of subclinical dysfunction has been recommended in an expert consensus document and is being used with increasing frequency. The role of experience in the precision and validity of GLS measurement is unknown, as is the efficacy of training. Methods Fifty-eight readers, divided into 4 groups on the basis of their experience with GLS, calculated GLS from speckle strain analysis of 9 cases with various degrees of image quality. Intraclass correlation coefficients (ICCs), mean difference, standard deviation (SD), and coefficient of variation (CV) were compared against the measurements of a reference group that had experience with >1,000 cases of strain measurement. Individualized feedback was distributed, and repeat measurements were performed by 40 readers. Comparisons with the baseline variation provided information about whether feedback was effective. Results The ICC for GLS was significantly greater than that for ejection fraction regardless of image quality. Experience with strain measurement affected the concordance in strain values among the readers; the group with the highest level of experience showed significantly better ICC than those with no experience, although the ICC of the inexperienced readers was still very good (0.996 vs. 0.975, p = 0.0002). As experience increased, the mean difference, SD, and CV became significantly smaller. The CV of segmental strain analysis showed significant improvement after training, regardless of experience. Conclusions The favorable interobserver agreement of GLS makes it more attractive than ejection fraction for follow-up of left ventricular function by multiple observers. Although experience is important, the precision of GLS was high for all groups. Training appears to be of most value for the assessment of segmental strain.
ISSN:1936-878X
1876-7591
DOI:10.1016/j.jcmg.2016.06.012