Speckle tracking echocardiography in healthy children: comparison between the QLAB by Philips and the EchoPAC by General Electric
Speckle tracking echocardiography (STE) has become a useful tool in cardiology but remains scarcely developed in pediatrics. We aimed to evaluate the feasibility of STE analyses in healthy children and compare reliability of STE for left and right ventricles (LV, RV) between the EchoPAC (GE Healthcare) and the QLAB (Philips Healthcare) software systems. Healthy children were screened for this prospective cross-sectional study. Analyses were performed upon five levels of variability: intra/inter-ultrasound system, intra/inter-sonographer and intra/inter-analyzer. The feasibility was measured, and the tracking quality informed. The study included 156 healthy children. Mean age was 7.6 ± 5 years [1 month–16.8 years]. Conventional echocardiography variables were similar in both ultrasound systems. For both software brands, the tracking quality was excellent in the LV longitudinal and circumferential displacements, but more limited in the RV free wall longitudinal strain. Inter-ultrasound system correlation was poor for global longitudinal and circumferential LV strain (ICC of 0.34 [IC95% 0.06–0.57]) and 0.12 [IC95% − 0.18 to − 0.40], respectively). We observed poor inter-sonographer reliability for both global LV longitudinal strain and global LV circumferential strain with the two software systems. Inter-analyzer variability was good especially for the global LV circumferential strain using Philips software (ICC of 0.78 [IC95% 0.52–0.91]). In pediatrics, the Philips/GE inter-vendor level of variability in STE analysis is mainly due to inter ultrasound systems and inter sonographers’ differences. These results need to be taken into account when using STE analysis in the follow-up of cardiac children. Clinicaltrials.gov: NCT02056925.
Keywords2D strain Inter-vendor Variability Pediatrics Pediatric cardiology
We thank Anne Cadene for the quality of study monitoring.
This work was supported by an institutional clinical research program from Montpellier University Hospital [Grant Reference Number UF9167].
Compliance with ethical standards
Conflict of interest
Authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by South Mediterranean IV Ethics Committee (2013-A00579-36).
Informed consent was obtained from all parents or legal guardians of children included in the study.
- 1.D’Hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, Rademakers F, Hatle L, Suetens P, Sutherland GR (2000) Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 1(3):154–170. https://doi.org/10.1053/euje.2000.0031 CrossRefPubMedGoogle Scholar
- 2.Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zaca V, Ballo P, D’Andrea A, Muraru D, Losi M, Agricola E, D’Errico A, Buralli S, Sciomer S, Nistri S, Badano L, Echocardiography Study Group Of The Italian Society Of C (2011) Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 30(1):71–83CrossRefGoogle Scholar
- 3.Teske AJ, De Boeck BW, Melman PG, Sieswerda GT, Doevendans PA, Cramer MJ (2007) Echocardiographic quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue Doppler and speckle tracking. Cardiovasc Ultrasound 5:27. https://doi.org/10.1186/1476-7120-5-27 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Kosmala W, Plaksej R, Strotmann JM, Weigel C, Herrmann S, Niemann M, Mende H, Stork S, Angermann CE, Wagner JA, Weidemann F (2008) Progression of left ventricular functional abnormalities in hypertensive patients with heart failure: an ultrasonic two-dimensional speckle tracking study. J Am Soc Echocardiogr 21(12):1309–1317. https://doi.org/10.1016/j.echo.2008.10.006 CrossRefPubMedGoogle Scholar
- 6.Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J 3rd (2006) Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 113(7):960–968. https://doi.org/10.1161/CIRCULATIONAHA.105.571455 CrossRefPubMedGoogle Scholar
- 7.Anwar S, Negishi K, Borowszki A, Gladding P, Popovic ZB, Erenberg F, Thomas JD (2017) Comparison of two-dimensional strain analysis using vendor-independent and vendor-specific software in adult and pediatric patients. JRSM Cardiovasc Dis 6:2048004017712862. https://doi.org/10.1177/2048004017712862 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Lorch SM, Ludomirsky A, Singh GK (2008) Maturational and growth-related changes in left ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population. J Am Soc Echocardiogr 21(11):1207–1215. https://doi.org/10.1016/j.echo.2008.08.011 CrossRefPubMedGoogle Scholar
- 10.Marcus KA, Mavinkurve-Groothuis AM, Barends M, van Dijk A, Feuth T, de Korte C, Kapusta L (2011) Reference values for myocardial two-dimensional strain echocardiography in a healthy pediatric and young adult cohort. J Am Soc Echocardiogr 24(6):625–636. https://doi.org/10.1016/j.echo.2011.01.021 CrossRefPubMedGoogle Scholar
- 12.Basu S, Frank LH, Fenton KE, Sable CA, Levy RJ, Berger JT (2012) Two-dimensional speckle tracking imaging detects impaired myocardial performance in children with septic shock, not recognized by conventional echocardiography. Pediatr Crit Care Med 13(3):259–264. https://doi.org/10.1097/PCC.0b013e3182288445 CrossRefPubMedGoogle Scholar
- 13.Cabrera AG, Chen DW, Pignatelli RH, Khan MS, Jeewa A, Mery CM, McKenzie ED, Fraser CD Jr (2015) Outcomes of anomalous left coronary artery from pulmonary artery repair: beyond normal function. Ann Thorac Surg 99(4):1342–1347. https://doi.org/10.1016/j.athoracsur.2014.12.035 CrossRefPubMedGoogle Scholar
- 14.Friedberg MK, Slorach C (2008) Relation between left ventricular regional radial function and radial wall motion abnormalities using two-dimensional speckle tracking in children with idiopathic dilated cardiomyopathy. Am J Cardiol 102(3):335–339. https://doi.org/10.1016/j.amjcard.2008.03.064 CrossRefPubMedGoogle Scholar
- 15.Mingo-Santos S, Monivas-Palomero V, Garcia-Lunar I, Mitroi CD, Goirigolzarri-Artaza J, Rivero B, Oteo JF, Castedo E, Gonzalez-Mirelis J, Cavero MA, Gomez-Bueno M, Segovia J, Alonso-Pulpon L (2015) Usefulness of two-dimensional strain parameters to diagnose acute rejection after heart transplantation. J Am Soc Echocardiogr 28(10):1149–1156. https://doi.org/10.1016/j.echo.2015.06.005 CrossRefPubMedGoogle Scholar
- 17.Costa SP, Beaver TA, Rollor JL, Vanichakarn P, Magnus PC, Palac RT (2014) Quantification of the variability associated with repeat measurements of left ventricular two-dimensional global longitudinal strain in a real-world setting. J Am Soc Echocardiogr 27(1):50–54. https://doi.org/10.1016/j.echo.2013.08.021 CrossRefPubMedGoogle Scholar
- 18.Levy PT, Sanchez Mejia AA, Machefsky A, Fowler S, Holland MR, Singh GK (2014) Normal ranges of right ventricular systolic and diastolic strain measures in children: a systematic review and meta-analysis. J Am Soc Echocardiogr 27(5):549–560. https://doi.org/10.1016/j.echo.2014.01.015.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Okumura K, Humpl T, Dragulescu A, Mertens L, Friedberg MK (2014) Longitudinal assessment of right ventricular myocardial strain in relation to transplant-free survival in children with idiopathic pulmonary hypertension. J Am Soc Echocardiogr 27(12):1344–1351. https://doi.org/10.1016/j.echo.2014.09.002 CrossRefPubMedGoogle Scholar
- 21.Eindhoven JA, Menting ME, van den Bosch AE, McGhie JS, Witsenburg M, Cuypers JA, Boersma E, Roos-Hesselink JW (2015) Quantitative assessment of systolic right ventricular function using myocardial deformation in patients with a systemic right ventricle. Eur Heart J Cardiovasc Imaging 16(4):380–388. https://doi.org/10.1093/ehjci/jeu194 CrossRefPubMedGoogle Scholar
- 22.Kalogeropoulos AP, Deka A, Border W, Pernetz MA, Georgiopoulou VV, Kiani J, McConnell M, Lerakis S, Butler J, Martin RP, Book WM (2012) Right ventricular function with standard and speckle-tracking echocardiography and clinical events in adults with D-transposition of the great arteries post atrial switch. J Am Soc Echocardiogr 25(3):304–312. https://doi.org/10.1016/j.echo.2011.12.003 CrossRefPubMedGoogle Scholar
- 24.Alghamdi MH, Mertens L, Lee W, Yoo SJ, Grosse-Wortmann L (2013) Longitudinal right ventricular function is a better predictor of right ventricular contribution to exercise performance than global or outflow tract ejection fraction in tetralogy of Fallot: a combined echocardiography and magnetic resonance study. Eur Heart J Cardiovasc Imaging 14(3):235–239. https://doi.org/10.1093/ehjci/jes137 CrossRefPubMedGoogle Scholar
- 27.Ladouceur M, Redheuil A, Soulat G, Delclaux C, Azizi M, Patel M, Chatellier G, Legendre A, Iserin L, Boudjemline Y, Bonnet D, Mousseaux E, Investigators S (2016) Longitudinal strain of systemic right ventricle correlates with exercise capacity in adult with transposition of the great arteries after atrial switch. International journal of cardiology 217:28–34. https://doi.org/10.1016/j.ijcard.2016.04.166 CrossRefPubMedGoogle Scholar
- 29.Koopman LP, Slorach C, Hui W, Manlhiot C, McCrindle BW, Friedberg MK, Jaeggi ET, Mertens L (2010) Comparison between different speckle tracking and color tissue Doppler techniques to measure global and regional myocardial deformation in children. J Am Soc Echocardiogr 23(9):919–928. https://doi.org/10.1016/j.echo.2010.06.014 CrossRefPubMedGoogle Scholar
- 30.Nagata Y, Takeuchi M, Mizukoshi K, Wu VC, Lin FC, Negishi K, Nakatani S, Otsuji Y (2015) Intervendor variability of two-dimensional strain using vendor-specific and vendor-independent software. J Am Soc Echocardiogr 28(6):630–641. https://doi.org/10.1016/j.echo.2015.01.021 CrossRefPubMedGoogle Scholar
- 32.Shiino K, Yamada A, Ischenko M, Khandheria BK, Hudaverdi M, Speranza V, Harten M, Benjamin A, Hamilton-Craig CR, Platts DG, Burstow DJ, Scalia GM, Chan J (2017) Intervendor consistency and reproducibility of left ventricular 2D global and regional strain with two different high-end ultrasound systems. Eur Heart J Cardiovasc Imaging 18(6):707–716. https://doi.org/10.1093/ehjci/jew120 CrossRefPubMedGoogle Scholar
- 33.Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, Song JH, Hamilton J, Sengupta PP, Kolias TJ, d’Hooge J, Aurigemma GP, Thomas JD, Badano LP (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr 28(2):183–193. https://doi.org/10.1016/j.echo.2014.11.003 CrossRefGoogle Scholar
- 34.Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, Geva T (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23(5):465–495. https://doi.org/10.1016/j.echo.2010.03.019 quiz 576 – 467.CrossRefPubMedGoogle Scholar
- 39.Spurney CF, McCaffrey FM, Cnaan A, Morgenroth LP, Ghelani SJ, Gordish-Dressman H, Arrieta A, Connolly AM, Lotze TE, McDonald CM, Leshner RT, Clemens PR (2015) Feasibility and reproducibility of echocardiographic measures in children with muscular dystrophies. J Am Soc Echocardiogr 28(8):999–1008. https://doi.org/10.1016/j.echo.2015.03.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Raman SV, Hor KN, Mazur W, He X, Kissel JT, Smart S, McCarthy B, Roble SL, Cripe LH (2017) Eplerenone for early cardiomyopathy in Duchenne muscular dystrophy: results of a two-year open-label extension trial. Orphanet journal of rare diseases 12(1):39. https://doi.org/10.1186/s13023-017-0590-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Muraru D, Onciul S, Peluso D, Soriani N, Cucchini U, Aruta P, Romeo G, Cavalli G, Iliceto S, Badano LP (2016) Sex- and method-specific reference values for right ventricular strain by 2-dimensional speckle-tracking echocardiography. Circ Cardiovasc Imaging 9(2):e003866. https://doi.org/10.1161/CIRCIMAGING.115.003866 CrossRefPubMedGoogle Scholar
- 42.Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, Kane GC (2015) Reference values for right ventricular strain in patients without cardiopulmonary disease: a prospective evaluation and meta-analysis. Echocardiography 32(5):787–796. https://doi.org/10.1111/echo.12806 CrossRefPubMedGoogle Scholar
- 44.Goudar SP, Baker GH, Chowdhury SM, Reid KJ, Shirali G, Scheurer MA (2016) Interpreting measurements of cardiac function using vendor-independent speckle tracking echocardiography in children: a prospective, blinded comparison with catheter-derived measurements. Echocardiography 33(12):1903–1910. https://doi.org/10.1111/echo.13347 CrossRefPubMedPubMedCentralGoogle Scholar