Head-to-Head Comparison of Global and Regional Two-Dimensional Speckle Tracking Strain Versus Cardiac Magnetic Resonance Tagging in a Multicenter Validation Study

Circ Cardiovasc Imaging. 2017 Nov;10(11):e006530. doi: 10.1161/CIRCIMAGING.117.006530.


Background: Despite widespread use to characterize and refine prognosis, validation data of two-dimensional (2D) speckle tracking (2DST) echocardiography myocardial strain measurement remain scarce.

Methods and results: Global and regional subendocardial peak-systolic Lagrangian longitudinal (LS) and circumferential strain (CS) by 2DST and 2D-tagged (2DTagg) cardiac magnetic resonance imaging were compared against sonomicrometry in a dynamic heart phantom and among each other in 136 patients included prospectively at 2 centers. The ability of regional LS and CS 2DST and 2DTagg to identify late gadolinium enhancement was compared using receiver operating characteristics curves. In vitro, both LS-2DST and 2DTagg highly agreed with sonomicrometry (intraclass correlation coefficient [ICC], 0.89 and ICC, 0.90, both P<0.001 with -3±2.8% and 0.34±4.35% bias, respectively). In patients, both global LS and global CS 2DST agreed well with 2DTagg (ICC, 0.89 and ICC, 0.80; P<0.001); however, they provided systematically greater values (relative bias of -37±27% and -25±37% for global LS and global CS, respectively). On regional basis, however, ICC (from 0.17 to 0.81) and relative bias (from -9 to -98%) between 2DST and 2DTagg varied strongly among segments. Ability to discriminate infarcted versus noninfarcted segments by late gadolinium enhancement was similarly good for regional LS 2DTagg and 2DST (area under the curve, 0.66 versus 0.59; P=0.08), while it was lower for CS 2DST than 2DTagg (area under the curve, 0.61 versus 0.75; P<0.001).

Conclusions: The high accuracy against sonomicrometry and good agreement of global LS and global CS by 2DST and 2DTagg confirm the overall validity of 2DST strain measurement. Yet, higher intertechnique segmental variability and lower ability for detecting infarct suggest that 2DST strain estimates may be less performant on regional than on global basis.

Keywords: 2-dimensional; echocardiography; magnetic resonance imaging; software validation; speckle tracking; strain.

Publication types

  • Comparative Study
  • Multicenter Study
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Belgium
  • Biomechanical Phenomena
  • Case-Control Studies
  • Contrast Media / administration & dosage
  • Echocardiography / instrumentation
  • Echocardiography / methods*
  • Female
  • France
  • Heart Diseases / diagnostic imaging*
  • Heart Diseases / physiopathology
  • Humans
  • Image Interpretation, Computer-Assisted
  • Magnetic Resonance Imaging, Cine* / instrumentation
  • Male
  • Middle Aged
  • Myocardial Contraction*
  • Organometallic Compounds / administration & dosage
  • Phantoms, Imaging
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Software Validation
  • Stress, Mechanical
  • Stroke Volume
  • Ventricular Function, Left*


  • Contrast Media
  • Organometallic Compounds
  • gadobutrol