Variability and Reproducibility of Segmental Longitudinal Strain Measurement: A Report From the EACVI-ASE Strain Standardization Task Force

EACVI-ASE-Industry Standardization Task Force

Research output: Contribution to journalArticlepeer-review

139 Scopus citations


Objectives In this study, we compared left ventricular (LV) segmental strain measurements obtained with different ultrasound machines and post-processing software packages. Background Global longitudinal strain (GLS) has proven to be a reproducible and valuable tool in clinical practice. Data about the reproducibility and intervendor differences of segmental strain measurements, however, are missing. Methods We included 63 volunteers with cardiac magnetic resonance–proven infarct scar with segmental LV function ranging from normal to severely impaired. Each subject was examined within 2 h by a single expert sonographer with machines from multiple vendors. All 3 apical views were acquired twice to determine the test-retest and the intervendor variability. Segmental longitudinal peak systolic, end-systolic, and post-systolic strain were measured using 7 vendor-specific systems (Hitachi, Tokyo, Japan; Esaote, Florence, Italy; GE Vingmed Ultrasound, Horten, Norway; Philips, Andover, Massachusetts; Samsung, Seoul, South Korea; Siemens, Mountain View, California; and Toshiba, Otawara, Japan) and 2 independent software packages (Epsilon, Ann Arbor, Michigan; and TOMTEC, Unterschleissheim, Germany) and compared among vendors. Results Image quality and tracking feasibility differed among vendors (analysis of variance, p < 0.05). The absolute test-retest difference ranged from 2.5% to 4.9% for peak systolic, 2.6% to 5.0% for end-systolic, and 2.5% to 5.0% for post-systolic strain. The average segmental strain values varied significantly between vendors (up to 4.5%). Segmental strain parameters from each vendor correlated well with the mean of all vendors (r2 range 0.58 to 0.81) but showed very different ranges of values. Bias and limits of agreement were up to −4.6 ± 7.5%. Conclusions In contrast to GLS, LV segmental longitudinal strain measurements have a higher variability on top of the known intervendor bias. The fidelity of different software to follow segmental function varies considerably. We conclude that single segmental strain values should be used with caution in the clinic. Segmental strain pattern analysis might be a more robust alternative.

Original languageEnglish (US)
Pages (from-to)15-24
Number of pages10
JournalJACC: Cardiovascular Imaging
Issue number1
StatePublished - Jan 1 2018


  • intervendor bias
  • segmental strain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Variability and Reproducibility of Segmental Longitudinal Strain Measurement: A Report From the EACVI-ASE Strain Standardization Task Force'. Together they form a unique fingerprint.

Cite this