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J Am Soc Echocardiogr. 2017 Nov;30(11):1081-1090. doi: 10.1016/j.echo.2017.06.010. Epub 2017 Aug 7.

Left Ventricular Global Strain Analysis by Two-Dimensional Speckle-Tracking Echocardiography: The Learning Curve.

Author information

1
School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Department of Cardiology, Prince Charles Hospital, Brisbane, Australia. Electronic address: jonathan.chan@griffith.edu.au.
2
School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Department of Cardiology, Fujita-Health University, Nagoya, Japan.
3
Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom.
4
Department of Cardiology, Prince Charles Hospital, Brisbane, Australia.
5
School of Medicine, University of Queensland, Brisbane, Australia.
6
Department of Cardiology, Fujita-Health University, Nagoya, Japan.
7
Department of Cardiology, Prince Charles Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
8
Department of Cardiology, La Zarzuela and Ramón y Cajal University Hospital, Madrid, Spain.

Abstract

BACKGROUND:

The application of left ventricular (LV) global strain by speckle-tracking is becoming more widespread, with the potential for incorporation into routine clinical echocardiography in selected patients. There are no guidelines or recommendations for the training requirements to achieve competency. The aim of this study was to determine the learning curve for global strain analysis and determine the number of studies that are required for independent reporting.

METHODS:

Three groups of novice observers (cardiology fellows, cardiac sonographers, medical students) received the same standardized training module prior to undertaking retrospective global strain analysis on 100 patients over a period of 3 months. To assess the effect of learning, quartiles of 25 patients were read successively by each blinded observer, and the results were compared to expert for correlation.

RESULTS:

Global longitudinal strain (GLS) had uniform learning curves and was the easiest to learn, requiring a minimum of 50 patients to achieve expert competency (intraclass correlation coefficient > 0.9) in all three groups over a period of 3 months. Prior background knowledge in echocardiography is an influential factor affecting the learning for interobserver reproducibility and time efficiency. Short-axis strain analysis using global circumferential stain and global radial strain did not yield a comprehensive learning curve, and expert level was not achieved by the end of the study.

CONCLUSIONS:

There is a significant learning curve associated with LV strain analysis. We recommend a minimum of 50 studies for training to achieve competency in GLS analysis.

KEYWORDS:

Learning curve; Speckle-tracking echocardiography; Strain

PMID:
28797723
DOI:
10.1016/j.echo.2017.06.010
[Indexed for MEDLINE]

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