Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
Philips Clinical Research Board, Suresnes, France.
J Am Soc Echocardiogr. 2018 Sep;31(9):1021-1033.e1. doi: 10.1016/j.echo.2018.04.009. Epub 2018 Jun 21.
In prior work, the authors demonstrated that two-dimensional speckle-tracking (2DST) correlated well but systematically overestimated global longitudinal strain (LS) and circumferential strain (CS) compared with two-dimensional cardiac magnetic resonance tagging (2DTagg) and had poor agreement on a segmental basis. Because three-dimensional speckle-tracking (3DST) has recently emerged as a new, more comprehensive evaluation of myocardial deformation, this study was undertaken to evaluate whether it would compare more favorably with 2DTagg than 2DST.
In a prospective two-center trial, 119 subjects (29 healthy volunteers, 63 patients with left ventricular dysfunction, and 27 patients with left ventricular hypertrophy) underwent 2DST, 3DST, and 2DTagg. Global, regional (basal, mid, and apical), and segmental (18 and 16 segments per patient) LS and CS by 2DST and 3DST were compared with 2DTagg using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Test-retest reproducibility of 3DST and 2DST was compared in 48 other patients.
Both global LS and CS by 3DST agreed better with 2DTagg (ICC = 0.89 and ICC = 0.83, P < .001 for both; bias = 0.5 ± 2.3% and 0.2 ± 3%) than 2DST (ICC = 0.65 and ICC = 0.55, P < .001 for both; bias = -5.5 ± 2.5% and -7 ± 5.3%). Unlike 2DST, 3DST did not overestimate deformation at the regional and particularly the apical levels and at the segmental level had lower bias (LS, 0.8 ± 2.8% vs -5.3 ± 2.4%; CS, -0.01 ± 2.8% vs -7 ± 2.8%, respectively) but similar agreement with 2DST (LS: ICC = 0.58 ± 0.16 vs 0.56 ± 0.12; CS: ICC = 0.58 ± 0.12 vs 0.51 ± 0.1) with 2DTagg. Finally, 3DST had similar global LS, but better global CS test-retest variability than 2DST.
Using 2DTagg as reference, 3DST had better agreement and less bias for global and regional LS and CS. At the segmental level, 3DST demonstrated comparable agreement but lower bias versus 2DTagg compared with 2DST. Also, test-retest variability for global CS by 3DST was better than by 2DST. This suggests that 3DST is superior to 2DST for analysis of global and regional myocardial deformation, but further refinement is needed for both 3DST and 2DST at the segmental level.
在之前的研究中，作者证实二维斑点追踪（2DST）与二维心脏磁共振标记（2DTagg）相比，虽然相关性良好，但系统地高估了整体纵向应变（LS）和周向应变（CS），且在节段性基础上一致性较差。由于三维斑点追踪（3DST）最近已成为心肌变形的一种新的、更全面的评估方法，因此进行本研究旨在评估与 2DTagg 相比，3DST 是否会优于 2DST。
在一项前瞻性的双中心试验中，119 例患者（29 例健康志愿者、63 例左心室功能障碍患者和 27 例左心室肥厚患者）接受了 2DST、3DST 和 2DTagg 检查。使用组内相关系数（ICC）和 Bland-Altman 分析比较 2DST 和 3DST 的全局、区域（基底、中部和顶部）和节段（每位患者 18 和 16 个节段）LS 和 CS，与 2DTagg 进行比较。另外 48 例患者比较了 3DST 和 2DST 的重复测试可重复性。
3DST 的全局 LS 和 CS 与 2DTagg 的一致性均优于 2DST（ICC 分别为 0.89 和 0.83，P 均<0.001；偏倚分别为 0.5 ± 2.3%和 0.2 ± 3%），与 2DST 相比（ICC 分别为 0.65 和 0.55，P 均<0.001；偏倚分别为-5.5 ± 2.5%和-7 ± 5.3%）。与 2DST 不同，3DST 并未高估区域和特别是心尖水平的变形，并且在节段性水平上具有较低的偏差（LS 为 0.8 ± 2.8% vs -5.3 ± 2.4%；CS 为-0.01 ± 2.8% vs -7 ± 2.8%），但与 2DST 相比，与 2DTagg 的一致性相似（LS：ICC 分别为 0.58 ± 0.16 和 0.56 ± 0.12；CS：ICC 分别为 0.58 ± 0.12 和 0.51 ± 0.1）。最后，3DST 的 LS 全局具有相似的一致性，但 CS 全局的测试-重测变异性优于 2DST。
以 2DTagg 为参考，3DST 在 LS 和 CS 的全局和区域方面具有更好的一致性和更低的偏差。在节段性水平上，3DST 与 2DTagg 相比，具有可比的一致性，但偏差更低，与 2DST 相比。此外，3DST 的 CS 全局测试-重测变异性优于 2DST。这表明 3DST 在分析整体和区域心肌变形方面优于 2DST，但在节段性水平上，3DST 和 2DST 都需要进一步改进。
