Left ventricular global myocardial strain assessment comparing
the reproducibility of four commercially available CMR-feature
Received: 25 January 2018 /Revised: 3 May 2018 /Accepted: 14 May 2018
European Society of Radiology 2018
Objectives To compare the reproducibility of cardiovascular magnetic resonance feature-tracking (CMR-FT) packages to assess
global left ventricular (LV) myocardial strain.
Methods In 45 subjects (i.e. 15 controls, 15 acute myocardial infarction, 15 dilated cardiomyopathy patients), we determined
inter-vendor, inter-observer (two readers) and intra-observer reproducibility of peak systolic global radial, circumferential and
longitudinal strain (GRS, GCS and GLS, respectively) comparing four commercially available software packages. Differences
between vendors were assessed with analysis of variance (ANOVA), between observers and readings with intraclass correlation
coefficient (ICC) and coefficient of variation (CV).
Results The normalised end-diastolic volume was 91, 77 and 119 ml/m
(median, Q1, Q3) and ejection fraction was 41 ± 14%,
range 12-67%. Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) values were
13.9% ± 5.4% (3.9-23.8%), 12.2% ± 5.8% (1.0-25.1%) and 32.0% ± 14.7 (3.6-67.8%), respectively. ANOVA showed significant
differences between vendors for GRS (p <0.001)andGLS(p = 0.018), not for GCS (p = 0.379). No significant bias was found
for both intra- and inter-observer variability. The ICC for inter- and intra-observer reproducibility ranged 0.828-0.991 and 0.902-
0.997, respectively. The CV, however, ranged considerably, i.e. 4.0-28.8% and 2.8- 27.7% for inter- and intra-observer repro-
ducibility, respectively. In particular, for GRS differences in CV values between vendors were large, i.e. 5.2-28.8% and 2.8-
27.7%, for inter- and intra-observer reproducibility, respectively.
Conclusions In a cohort of subjects with a wide range of cardiac performances, GRS and GLS values are not interchangeable
between vendors. Moreover, although intra- and inter-observer reproducibility amongst vendors is excellent, some vendors
encounter problems to reproducibly measure global radial strain.
Barreiro-Pérez and Curione equally contributed to the manuscript.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-018-5538-4) contains supplementary
material, which is available to authorized users.
* Jan Bogaert
Department of Imaging and Pathology, KU Leuven – University of
Leuven, Herestraat 49, 3000 Leuven, Belgium
Servicio de Cardiología, Hospital Universitario de Salamanca,
Instituto de Investigación Biomédica de Salamanca (IBSAL),
Facultad de Medicina, Universidad de Salamanca, y CIBERCV,
Laboratory on Cardiovascular Imaging & Dynamics, Department of
Cardiovascular Sciences, KU Leuven – University of Leuven,
Herestraat 49, Leuven, Belgium
Department of Cardiovascular Sciences, KU Leuven – University of
Leuven, Herestraat 49, Leuven, Belgium