Two-dimensional images were acquired using the Epiq 7 ultrasound system. Echocardiographic image acquisition and analysis This study was approved by the Institutional Review Board at our institution. To ensure age diversity, equal numbers of patients were randomly selected from three age range cohorts for each clinical group: 0-6y > 6-12y > 12-18y. Group 1 patients had been referred for echocardiography with an indication of murmur/ palpitations/ family history of congenital heart disease, and had been found to have normal heart structure, function, blood pressure for their age, and no evidence of pulmonary hypertension. All patients had biventricular circulation and high-quality 2D echocardiographic images. These groups were chosen to represent a broad variety of patterns of ventricular conduction. The patients were chosen from three groups: (1) normal heart structure and function (2) ventricular paced rhythm with a wide QRS (duration of ≥120 msec) (3) abnormal septal contour with flattened ventricular septum (in systole or diastole, due to either right ventricular pressure or volume-overload lesions). We performed a single-center, retrospective analysis of data from pediatric patients (≤18 years old). Accordingly, the aim of this study was to evaluate the variability of analyses derived from speckle tracking echocardiography using three popular software platforms (QLAB 10.5, 10.8, and TomTec 1.2) for the measurement of longitudinal strain, circumferential strain, and synchrony. We hypothesized that different modern analysis packages may produce different results in both strain and synchrony values in children, independent of acquisition. A paucity of evidence on inter-vendor synchrony differences currently exists, with only a single study published in adults, and none in children. Recent studies in adults and children, as well as an international task force for deformation imaging, have investigated the variations in reported values of strain from different packages. Strain and synchrony can be calculated with the use of a variety of analysis packages, some of which are vendor-specific, while others are vendor-independent. In addition, LV strain is correlated with synchrony and their interdependence plays an important role in managing patients with both congenital and acquired heart disease. Left ventricular (LV) strain by two-dimensional (2D) speckle-tracking echocardiography has been shown to be a reliable and clinically important method of quantitatively characterizing cardiac function in children. These data suggest that reliable comparisons between strain values derived from QLAB and TomTec is possible in certain cases, but that caution should be used especially in different hemodynamics conditions. In TomTec, low and high frame rate strain values differed only in a subset of patients (flattened septum). Quantification smoothness settings in QLAB 10.8 resulted in minimal strain differences. Strain values varied widely between QLAB 10.5 and all other software packages, recommending avoidance of QLAB 10.5 for future studies. Synchrony values varied substantially among all packages in children. Quantification smoothness changes in QLAB 10.8 did not impact strain significantly in any patient group temporal resolution changes in TomTec resulted in strain differences in children with flat ventricular septums, but not those with normal or ventricular paced hearts. Synchrony values varied widely for all strain values ( p < 0.001 for both) in all packages. AP4 and SAXM strain values varied significantly between QLAB 10.5 and the other packages. Tracking scores were high for all packages except QLAB 10.5 in the SAXM view. A mixed-effects linear regression model was used, with main effect considered significant if the p-value was < 0.05. AP4 and SAXM strain and synchrony values were recorded. Tracking quality for each package was graded. In TomTec, images were analyzed with both low and high frame rates. In QLAB version 10.8, low, medium, and high quantification smoothness settings were employed. We analyzed the same image acquired from the apical 4-chamber (AP4) and short-axis at the mid-papillary level (SAXM) views in both QLAB (versions 10.5 and 10.8) and TomTec (version 1.2). The study population included 108 children patients were divided into three groups: (1) normal cardiac structure and conduction (2) ventricular paced rhythm and (3) flattened ventricular septum (reflecting right ventricular pressure or volume load lesions). To test the hypothesis that different packages may affect results, independent of acquisition, we compared values obtained using two commercially available analysis tool (QLAB and TomTec), with several different settings. Strain and synchrony can be calculated from a variety of software packages, but there is a paucity of data with inter-vendor comparisons in children.
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