Purpose: Two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE) enable assessment of myocardial function. Here we examined the agreement between 2D and 3D STE measurement of global longitudinal strain (GLS) in patients with normal left ventricle, reduced ejection fraction, and cardiac pacing.
Methods: Our analysis included 90 consecutive patients (59% males; average age: 73.2 ± 11.2 years) examined between May 2019–December 2020. Linear regression, Pearson correlation and Bland-Altman plot were used to quantify the association between 2D and 3D GLS, and related segments using the 17-segment American Heart Association (AHA) model. Analyses were performed in the entire study group and subgroups. Intra- and inter-observer variability of 2D and 3D GLS measurement was randomly tested in 15 out of 90 subjects.
Results: We observed a strong correlation between 2D and 3D GLS measurements (R = 0.76, P < 0.001), which was higher in males (R = 0.78, P < 0.001) than females (R = 0.69, P < 0.001). Associated segment correlation was poor (R = 0.2–0.5, P < 0.01). The correlation between 2D and 3D GLS was weaker in individuals with ventricular pacing of >50% (R = 0.62, P < 0.001) than <50% (R = 0.8, P < 0.001), and in patients with LVEF of <35% (R = 0.69, P = 0.002) than >35% (R = 0.72, P <0.001). Intra-observer variability for 2D and 3D GLS was 9.1 and 10.4%, respectively. Inter-observer variability for 2D and 3D GLS was 12 and 10.8%, respectively.
Conclusion Overall 2D and 3D GLS were closely associated, but not when analyzed per segment. It seems that GLS comparison is more representative of global shortening than local displacement. Right ventricular pacing and reduced left ventricular ejection fraction were associated with reduced correlation between 2D and 3D GLS.
