Three-dimensional speckle tracking echocardiography for the evaluation of segmental myocardial deformation

Abstract

Background: Although the feasibility of three-dimensional (3D) speckle tracking echocardiography (STE) for the evaluation of myocardial function has been demonstrated, the poor reproducibility of strain measurements obtained with 3D STE as compared to two-dimensional (2D) STE has been controversially discussed. Aim of this study was to demonstrate the benefit of longitudinal strain analysis by 3D STE as compared to the established 2D STE techniques. Methods: 2D and 3D STE was performed in 30 volunteers with normal systolic left ventricular (LV) function using cardiac ultrasound systems from two different vendors (Vivid E9 and iE33 xMATRIX). Global and segmental longi-tudinal strain (GLS, SLS) values were analyzed for 2D STE using respective software packages (Vivid E9: EchoPAC AFI; iE33 xMATRIX: QLAB CMQ 9.0). Measurements for 3D STE were performed using specific software for Vivid E9 (EchoPAC 4DAutoLVQ) and unspecific software for iE33 xMATRIX (TomTec Imaging Systems 4D left ventricular Analysis). Intra-, interobserver and test-retest variability as well as times for acquisition and analysis were compared between 2D and 3D STE techniques. Results: The reliability of SLS measurements using 3D STE was non-inferior to the measurements obtained by 2D STE, with perpetual constant results in all tests (ICC SLS 3D 0.78 – 0.94 vs. SLS 2D 0.73 – 0.93). Agreements between SLS values were better when vendor specific 2D and 3D software was applied. GLS measurements showed inhomogeneous results for both techniques (ICC GLS 3D 0.40 – 0.93 vs. GLS 2D 0.13 – 0.91). Acquisition time was significantly shorter for 3D datasets than for 2D datasets (3D 51.0 ± 10.66 sec vs. 2D 91.0 ± 10.9 sec, p < .01). Conclusion: 3D STE is a time-saving technology for the evaluation of myocardial deformation in daily clinical practice, generating results that are comparable to the conventional 2D STE techniques. SLS obtained by 3D STE seems to be a more robust parameter than GLS for the assessment of myocardial deformation, especially when vendor specific software packages are used.