Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.
Research Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.
Int J Cardiovasc Imaging. 2022 Feb;38(2):279-287. doi: 10.1007/s10554-021-02398-7. Epub 2021 Sep 6.
Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p < 0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.
全球应变(GLS)是监测心脏移植(HT)受者的有用工具。已有研究报道，在健康人群和不同情况下，GLS 测量存在重要的仪器间变异性，但 HT 患者中的证据仍然有限。我们使用两种仪器商（通用电气和飞利浦）在一组连续且稳定的成年 HT 受者中评估了 GLS 的可靠性和有效性。患者在超声心动图随访期间进行了两次同步 GLS 分析。我们使用 Bland-Altman 的一致性界限（LOA）图评估 GLS 的仪器间可靠性，计算其覆盖概率（CP）和组内相关系数（ICC）。通过接受者操作特征（ROC）曲线、GLS 的预测值、敏感性和特异性来评估有效性，以评估每个供应商检测正常左心室功能的能力。对 53 例稳定 HT 患者的 78 对 GLS 研究进行了分析。我们观察到仪器间的可靠性较差，LOA 较宽（不到 50%的数值落在 CP 2%之外，ICC 为 0.49）。ROC 分析（曲线下面积为 0.824 对 0.631，p<0.05）和诊断测试指标（敏感性为 0.73 对 0.64；特异性为 0.79 对 0.50）均表明 GE 优于飞利浦。HT 受者 GLS 分析的仪器间变异性超过了临床可接受的范围。与飞利浦相比，GE 软件的 GLS 似乎显示出更高的有效性。本研究为在 HT 患者的随访中，特别是当 GLS 由不同的仪器商测量时，对 GLS 的临床管理解释需要谨慎提供了证据。
