Abstract
BackgroundCardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software.MethodsIntra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers.ResultsTraining improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance.ConclusionObserver experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance.
Highlights
cardiovascular magnetic resonance (CMR) represents the reference standard in the assessment of cardiac morphology and function [1] without the limit of anatomical plane restrictions [2, 3]
Observer experience is an important source of variance in cardiovascular magnetic resonance feature tracking (CMR-FT) derived strain assessment
Raising evidence points towards incremental additional value of myocardial deformation assessment for clinical decision making beyond established markers for cardiovascular risk including left ventricular ejection fraction (LVEF) [10,11,12, 14, 18, 19]
Summary
CMR represents the reference standard in the assessment of cardiac morphology and function [1] without the limit of anatomical plane restrictions [2, 3]. CMR-FT is extensively used in cardiovascular research and increasingly in clinical practice It allows for comprehensive and reliable assessments of cardiac function [5,6,7,8,9,10] and has been applied to a broad range of cardiovascular diseases such as patients with dilated [11, 12] or ischemic [13] cardiomyopathy, after myocardial infarction [14,15,16] and in patients with complex cardiac malformations such as Ebstein’s Anomaly [17]. We aimed to determine the impact and benefits of training on the reproducibility and variability of CMR-FT employing different commercially available software solutions. Cardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. This study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software
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