Inter-technique agreement of left atrial and ventricular deformation analysis: a comparison between transthoracic echocardiography and cardiovascular magnetic resonance imaging

Aseel Alfuhied; Jian L Yeo; Gaurav S Gulsin; Abhishek Dattani; Kelly Parke; Christopher D Steadman; Manjit Sian; Anna-Marie Marsh; Gerry P McCann; Anvesha Singh

doi:10.1186/s44156-025-00090-3

Inter-technique agreement of left atrial and ventricular deformation analysis: a comparison between transthoracic echocardiography and cardiovascular magnetic resonance imaging

Echo Res Pract. 2025 Oct 6;12(1):24. doi: 10.1186/s44156-025-00090-3.

Authors

Affiliations

¹ Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK. aa1408@leicester.ac.uk.
² Department of Cardiovascular Technology-Echocardiography, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. aa1408@leicester.ac.uk.
³ Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
⁴ Department of Cardiology, University Hospitals Dorset, Poole, UK.

Abstract

Background: Myocardial strain measurements are increasingly used in research and clinical practice. However, there are limited data on inter-modality agreement and reproducibility. We aimed to investigate the inter-technique agreement of transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging derived left atrial (LA) and left ventricular (LV) deformation parameters.

Methods: Subjects with or without cardiovascular disease were prospectively recruited and had TTE and CMR on the same day. Ten subjects with type 2 diabetes (T2D) had both scans repeated within two weeks for test-retest reproducibility assessment. Myocardial deformation analyses were undertaken including LA strain (LAS) corresponding to LA reservoir, conduit and booster pump phases, LV global longitudinal strain (GLS) and peak early/late diastolic strain rate (PE/PLDSR) and LV mid-circumferential strain (Mid-CS) and strain rates.

Results: 222 participants (T2D (n = 87); severe aortic stenosis (n = 78) and healthy volunteers (n = 57)) were included. There were no significant differences between TTE and CMR measured LAS parameters, with moderate agreement between imaging modalities (ICC = 0.55-0.69). LV parameters were significantly higher on CMR except for Mid-CS which was higher on TTE (-19.3 ± 3.19 vs. -23.0 ± 4.37; p < 0.001). Inter-technique agreement was poor for all LV deformation parameters, except PLDSR with modest agreement (ICC = 0.52-0.66). CMR test-retest reproducibility was good to excellent for LAS and LV strain rate parameters (ICC = 0.73-0.90). TTE test-retest reproducibility was good for conduit LAS and LV_PEDSR (ICC = 0.80).

Conclusion: There is modest agreement between TTE and CMR for LAS and poor agreement for LV strain assessment, suggesting that these techniques cannot be used inter-changeably. In a small subset of participants CMR test-retest reproducibility was overall better than TTE.

Keywords: Aortic stenosis; Cardiovascular magnetic resonance; Left atrium; Left ventricle; Strain; Strain rate; Transthoracic echocardiography; Type 2 diabetes.

Abstract

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