Three-Dimensional Speckle Tracking Echocardiography for Automatic Assessment of Global and Regional Left Ventricular Function Based on Area Strain

Objective: We evaluated the ability of a novel automatic index based on area strain to reliably quantify global and regional left ventricular (LV) function and accurately identify wall motion (WM) abnormalities using three-dimensional speckle tracking echocardiography. Methods: A total of 140 consecutive patients underwent two-and three-dimensional echocardiography. Segmental WM assessment by area strain was compared with visual assessment of two-dimensional images by two experienced echocardiographers. For global LV function assessment, area strain was validated against LV ejection fraction (EF) and wall motion score index (WMSI). Observer reliability was assessed in all patients, whereas test-retest reliability was evaluated in a subgroup of 50 randomly selected patients. Normal reference values of area strain were determined in 56 healthy subjects. Results: Agreement of WM scores between area strain and visual assessment was found in 94% of normal, 55% of hypokinetic, and 91% of akinetic segments (kappa-coefficient 0.88). Sensitivity, specificity, and accuracy of area strain to distinguish abnormal segments from normal segments were 91%, 96%, and 94%, respectively. In regard to global LV function assessment, area strain was highly correlated with EF and WMSI (r = 0.91 and 0.88, respectively). Observer and test-retest reliability of area strain for quantitative assessment of global and regional LV function were good to excellent (all intraclass correlation coefficients >= 0.77). Intraobserver and interobserver reliability of semiquantitative segmental WM analysis by area strain (kappa-coefficients 0.87 and 0.73) were comparable to visual assessment by experienced echocardiographers (0.85 and 0.69, respectively). Conclusion: Area strain represents a promising novel automatic index that may provide an accurate and reproducible alternative to current echocardiographic standards for quantitative assessment of global and regional LV function. Area strain seems to adequately identify regional wall motion abnormalities compared with the clinical standard of visual assessment by experienced echocardiographers. (J Am Soc Echocardiogr 2011;24:314-21.)