Abstract Introduction Cardiac Shear Wave Elastography utilizes ultrafast echocardiographic imaging to assess myocardial stiffness through the propagation velocities of shear waves (SWs). Despite advancements, variability in SW speed measurements remains a challenge. Current assessment lacks a gold standard method and still relies on subjective visual assessment with manual measurements leading to inherent variability. Purpose Manual and nine semi-automatic algorithms for measuring SW speed were systematically tested, aiming to reduce variability and enhance reproducibility of the estimations. Methods High-frame-rate echocardiography images (1055±159 Hz) were acquired in parasternal long axis view. Anatomical M-modes were drawn along the septal wall. To visualize the SW, M-modes were color coded for tissue acceleration. SWs then appear as green bands, and their slopes correspond to tissue propagation velocity. SW slopes from healthy volunteers (n=67) and patients (n=53) with different cardiac conditions, covering a wide age range (19-89 years-old) were included to evaluate the performance of the methods in a clinical context. Measurements were performed manually and with 9 automatic methods: Time-frequency correlation (TFC), Regression window (RW), Radon Transform (RT), and 6 segmentation-based methods (e.g. maximum value). Automatic algorithms were initiated by indicating the position of SW by a mouse click. To assess reproducibility, this procedure was repeated 3 times for different sites along the SW. Failure of SW detection was counted to assess feasibility. Since the visualization of the SW’s and segmentation threshold depends on the selected color scale limits, 3 scales (0.5, 1, 2 m/s²) were tested (Figure 1). Finally, manual measurements served as reference, and agreement analysis was conducted. Results When accessing reproducibility across different starting points, only TFC exhibited variability (SD ±0.3 vs ±0.0 m/s for others). In terms of the color scale settings, RW and RT showed no variability (SD ±0.0 vs ± 0.3 m/s for manual), while Regression Weighted Maximum Value (RMW), emerged as the segmentation method with the least variability (SD ±0.1 m/s). RMW also showed highest feasibility [99%, (RW: 76% and RT: 90%)], correlation (r=0.77, r= 0.72, and r= 0.76 resp.), and agreement with a manual measurements (Figure 2). Conclusion Among the tested algorithms, Regression Weighted Maximum Value (RWM) demonstrated the highest feasibility, correlation and agreement with manual measurements. Our findings suggest this semi-automatic method provides an objective alternative to manual SW velocity estimations.
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