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Table 2 Echocardiographic parameters presented in all different examiner-analyst scenarios

From: Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training

Scenario

GLS

LVEF

Expert echocardiographer

A

Trainee analyst

−19.1% (±3.4)

54.5% (±8.2)

 

Expert analyst

−18.7% (±3.2)

53.6% (±8.6)

 

ICC

0.94 (0.84–0.97)

0.71 (0.47–0.84)

4.04 (p < 0.001) †

Fixed bias

−0.76% (−3.55–2.03)

−0.27% (−16.56–16.02)

0.40 (p = 0.692) *

Trainee echocardiographer

B

Trainee analyst

−19.4% (±3.5)

50.3% (±8.2)

 

Expert analyst

−18.3% (±3.5)

52.1% (±8.9)

 

ICC

0.91 (0.72–0.96)

0.76 (0.57–0.87)

2.49 (p < 0.001) †

Fixed bias

1.19% (−4.61–2.22)

−1.4% (−15.79–12.98)

2.36 (p < 0.02) *

Each operator analyzing their own images

C

Trainee

−19.4% (±3.5)

50.3% (±8.2)

 

Expert

−18.7% (±3.2)

53.6% (±8.6)

 

ICC

0.89 (0.74–0.95)

0.63 (0.32–0.80)

3.26 (p < 0.001) †

Fixed bias

−0.97% (−4.58–2.64)

−4.08% (−20.78–12.62)

2.45 (p < 0.02) *

Trainee analyst

D

Trainee Images

−19.4% (±3.5)

50.3% (±8.2)

 

Expert images

−19.1% (±3.4)

54.5% (±8.2)

 

ICC

0.93 (0.88–0.96)

0.13 (−0.45–0.49)

7.17 (< 0.001) †

Fixed bias

0.21% (−4.58–2.64)

−4.08% (−20.78–12.62)

− 0.02 (p = 0.98) *

Expert analyst

E

Trainee Images

−18.3% (±3.5)

52.1% (±8.9)

 

Expert images

−18.3% (±3.2)

53.6% (±8.6)

 

ICC

0.91 (0.84–0.95)

0.70 (0.47–0.83)

3.1 (0.002) †

Fixed bias

0,07 (−3.64–3.78)

−2.17 (−18.16–13.82)

1.84 (p = 0.07) *

Trainee imaging versus expert imaging

F

 

EDD

E/e’

 

ICC

0.91 (0.85–0.95)

0.92 (0.85–0.95)

 

Fixed bias

−0.43 mm

0.25

 
  1. Continuous data are presented as mean ± SD; GLS = global longitudinal strain, LVEF = left ventricular ejection fraction, EDD = left ventricle end diastolic diameter, E/e’ = early transmitral diastolic inflow divided by early diastolic mitral annular velocity, ICC = intra class correlation coefficient (95% confidence interval) compared with Z-score (†). Fixed bias, mean difference (95% confidence interval) compared with paired samples T-test (*). Results in this table are stratified in scenario A-E describing who obtained images and who performed the analysis. Results from comparing GLS and LVEF in each scenario are presented in the Z-score column. Parameters of diastolic function are listed in section F