© 2015, Wiley Periodicals, Inc. DOI: 10.1111/echo.12962

Echocardiography

Intervendor Variabilities of Left and Right Ventricular Myocardial Velocities among Three Tissue Doppler Echocardiography Systems Kiyoshi Abe, M.T.,* Satoshi Yuda, M.D., Ph.D.,†‡ Yasumi Sato, M.T.,* Kenji Yasui, M.T.,* Ryosuke Nishi, M.T.,§ Kyosuke Hanada, M.T.,§ Naoko Hashimoto, M.T.,§ Mina Kawamukai, M.D.,‡ Hidemichi Kouzu, M.D., Ph.D.,‡ Atsuko Muranaka, M.D., Ph.D.,‡ Akiyoshi Hashimoto, M.D., Ph.D.,‡ Kazufumi Tsuchihashi, M.D., Ph.D.,‡ Naoki Watanabe, M.D., Ph.D.,*† and Tetsuji Miura, M.D., Ph.D.‡ *Division of Laboratory Diagnosis, Sapporo Medical University Hospital, Sapporo, Japan; †Department of Infection Control and Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; ‡Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; and §Department of Clinical Laboratory, Hokkaido Prefectural School of Hygiene, Sapporo, Japan

Background: Whether an intervendor discordance of myocardial velocities determined by tissue Doppler echocardiography (TDE) can be generalized remains unclear. We compared intervendor variabilities of left ventricular (LV) and right ventricular (RV) myocardial velocities among three TDE systems. Methods: Examinations with TDE were performed in 41 healthy subjects and 11 patients with cardiovascular risk factors (CVR) using a-7 (V1, Hitachi Aloka Medical), Artida (V2, Toshiba Medical Systems), and Vivid E9 (V3, GE Healthcare) on the same day. Peak systolic (s0 ), early diastolic (e0 ), and late diastolic (a0 ) myocardial velocities at medial and lateral sites of the mitral annulus and lateral site of the tricuspid annulus were measured using both pulsed-wave TDE and color TDE. Intra-observer and inter-observer variabilities were determined in 10 subjects and test–retest variability in 14 subjects. Results: As for test–retest variability, reproducibilities of LV and RV myocardial velocities determined by pulsed-wave TDE and color TDE were relatively low but comparable between V1, V2, and V3. Myocardial velocities in healthy subjects determined by both pulsed-wave TDE and color TDE were significantly different among the three TDE systems. Myocardial velocities by pulsed-wave TDE in V3 were 2–12% lower (P < 0.05) than those by V2 and 5–14% lower (P < 0.05) than those by V1. Similar differences in myocardial velocities determined by both pulsed-wave TDE and color TDE were found in patients with CVR. Conclusions: LV and RV myocardial velocities determined by both pulsed-wave TDE and color TDE are vendor dependent, and reproducibility of the myocardial velocities determined by both TDE systems is relatively low. (Echocardiography 2015;32:1790–1801) Key words: tissue Doppler echocardiography, left ventricular function, right ventricular function, myocardial velocity, reproducibility, intervendor variability Tissue Doppler echocardiography (TDE) enables quantitative assessment of regional myocardial mechanics, and analysis of left ventricular (LV) and right ventricular (RV) functions by TDE has been increasingly used for various purposes, including assessment of ischemia, LV and RV functions, estimation of LV filling pressure, and detection of subclinical cardiac involvement in patients with systemic diseases.1,2 However, discordance of myocardial velocities determined by both pulsed-wave Address for correspondence and reprint requests: Satoshi Yuda, M.D., Ph.D., Department of Infection Control and Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo 060-0061, Japan. Fax: +81-11-644-7958; E-mail: [email protected]

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TDE and color TDE between three systems (i.e., GE vs. Phillips and Hewlett-Packard vs. Phillips) has been reported.3–5 Whether such an intervendor discordance can be generalized remains unclear, however, the concordance of myocardial velocities in other TDE systems, which have been used in many studies (e.g. Hitachi Aloka Medical and Toshiba),6–12 has not been elucidated. To address these issues, we compared intervendor variabilities of LV and RV myocardial velocities between Hitachi Aloka Medical, Toshiba, and GE TDE systems. Methods: Study Population: This study was a single-center, cross-sectional study conducted at Sapporo Medical University

Intervendor Variability of Tissue Doppler Echocardiography

Hospital, and informed consent was obtained from all study subjects and patients at the time of echocardiographic examinations. Forty-one healthy subjects (age 31  12 years, 63% men) without cardiovascular diseases, hypertension, dyslipidemia, or diabetes mellitus were enrolled for comparison of intervendor variabilities of LV and RV myocardial velocities among three commercially available TDE systems (N group). In this group of subjects, physical findings, ECG, and results of conventional echocardiography were all normal. In addition, we enrolled a separate group of 11 patients (age 50  12 years, 100% men) with cardiovascular risk factors to assess the intervendor variabilities in a broad range of myocardial velocities (CVR group). Data for cardiovascular risk factors were obtained from a clinical history taken before the echocardiographic examination. Hypertension was defined as systolic blood pressure of 140 mmHg and/or diastolic blood pressure of 90 mmHg or receiving antihypertensive therapy. Dyslipidemia was defined as low-density lipoprotein cholesterol ≥140 mg/dL, triglycerides >150 mg/dL, highdensity lipoprotein cholesterol 40 frames/ sec). For all color TDE systems, peak myocardial velocities during systole (s0 ), early diastole (e0 ), and late diastole (a0 ) were measured by placing a circular sample volume (5 or 6 mm in diameter) at the same sites of the mitral and tricuspid annulus as for the pulsed-wave TDE (Fig. 2) and the E/ e0 ratio was also calculated. Sample volume was fixed at each annulus site, and no tracking system was used in this study. These myocardial velocities were measured offline using the analysis software in each TDE system (TDI analysis for V1, UltraExtend Advanced Cardiac Package for V2, and EchoPAC BT11 for V3) by two investigators (R.N. and N.H.). To quantify discrepancy between myocardial velocity determined by pulsed-wave TDE and myocardial velocity in the same segment determined by color TDE, myocardial velocity ratio, which was defined as a ratio of myocardial velocity determined by pulsedwave TDE to myocardial velocity determined by color TDE, was calculated. Statistical Analysis: All continuous variables are expressed as means  SD. Differences in continuous variables between two groups were assessed by the Mann–Whitney U-test, and comparison among three groups was performed by the Kruskal–Wallis test followed by the Mann–Whitney U-test with Bonferroni’s correction for multiple comparisons. The intra-observer and inter-observer variabilities were determined in 10 subjects. For determination of the intra-observer variability, datasets were analyzed again 7 days after performing the initial measurements by a single observer (K.Y.). The inter-observer variability was determined by use of data from two separate observers (K.Y. and K.A.). In the pulsed-wave TDE, intra-observer and inter-observer variabilities were assessed by measuring the acquired records of myocardial velocity curves. In the color TDE, these variabilities were assessed by 1791

Abe, et al.

Figure 1. Representative measurements of myocardial velocities determined by pulsed-wave tissue Doppler echocardiography.

Figure 2. Representative measurements of myocardial velocities determined by color tissue Doppler echocardiography.

both placing a sample point at sites of the mitral and tricuspid annulus and measuring the myocardial velocities. The intervendor variability was determined by analyzing data among three commercially available TDE systems. Test– retest variability was determined in 14 subjects. 1792

Echocardiographic study in each subject was repeated within 10 minutes by different observers (K.Y. and K.A.). All measurements were made by each observer blind to previous measurements. The mean bias, the lower and upper limits of agreement, and the coefficient of variation

Intervendor Variability of Tissue Doppler Echocardiography

(CV) (absolute difference between the paired measurements divided by the average of the two measurements) were calculated. Reproducibility was assessed using an intra-class correlation coefficient (ICC). The clinical significance of ICC was interpreted as follows: excellent, ICC≥0.80; good, 0.60 ≤ ICC

Intervendor Variabilities of Left and Right Ventricular Myocardial Velocities among Three Tissue Doppler Echocardiography Systems.

Whether an intervendor discordance of myocardial velocities determined by tissue Doppler echocardiography (TDE) can be generalized remains unclear. We...
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