Comparison of left ventricular manual versus automated derived longitudinal strain: implications for clinical practice and research

Yukari Kobayashi, Miyuki Ariyama, Yuhei Kobayashi, Genevieve Giraldeau, Dominik Fleischman, Mirta Kozelj, Bojan Vrtovec, Euan Ashley, Tatiana Kuznetsova, Ingela Schnittger, David Liang, Francois Haddad

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Systolic global longitudinal strain (GLS) is emerging as a useful metric of ventricular function in heart failure and usually assessed using post-processing software. The purpose of this study was to investigate whether longitudinal strain (LS) derived using manual-tracings of ventricular lengths (manual-LS) can be reliable and time efficient when compared to LS obtained by post-processing software (software-LS). Apical 4-chamber view images were retrospectively examined in 50 healthy controls, 100 patients with dilated cardiomyopathy (DCM), and 100 with hypertrophic cardiomyopathy (HCM). We measured endocardial and mid-wall manual-LS and software-LS, using peak of average regional curve [software-LS(a)] and global ventricular lengths [software-LS(l)] according to definition of Lagragian strain. We compared manual-LS and software-LS by using Bland–Altman plot and coefficient of variation (COV). In addition, test–retest was also performed for further assessment of variability in measurements. While manual-LS was obtained in all subjects, software-LS could be obtained in 238 subjects (95 %). The time spent for obtaining manual-LS was significantly shorter than for the software-LS (94 ± 39 s vs. 141 ± 79 s, P < 0.001). Overall, manual-LS had an excellent correlation with both software-LS (a) (R2 = 0.93, P < 0.001) and software-LS(l) (R2 = 0.84, P < 0.001). The bias (95 %CI) between endocardial manual-LS and software-LS(a) was 0.4 % [−2.8, 3.6 %] in absolute and 3.5 % [−17.0, 24.0 %] in relative difference while it was 0.4 % [−2.5, 3.3 %] and 3.4 % [−16.2, 23.1 %], respectively with software-LS(l). Mid-wall manual-LS and mid-wall software-LS(a) also had good agreement [a bias (95 % CI) for absolute value of 0.1 % [−2.1, 2.5 %] in HCM, and 0.2 % [−2.2, 2.6 %] in controls]. The COV for manual and software derived LS were below 6 %. Test–retest showed good variability for both methods (COVs were 5.8 and 4.7 for endocardial and mid-wall manual-LS, and 4.6 and 4.9 for endocardial and mid-wall software-LS(a), respectively. Manual-LS appears to be as reproducible as software-LS; this may be of value especially when global strain is the metric of interest.

Original languageEnglish (US)
Pages (from-to)429-437
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Issue number3
StatePublished - Mar 1 2016
Externally publishedYes


  • Dilated cardiomyopathy
  • Echocardiography
  • Global longitudinal strain
  • Heart failure
  • Hypertrophic cardiomyopathy
  • Post-processing software
  • Strain imaging
  • Vendor-independent
  • Ventricular function

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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