Intraobserver and Interobserver Reproducibility for Radial, Circumferential and Longitudinal Strain Echocardiography

Leischik R*, 1, Dworrak B1, Hensel K2
1 Department of Cardiology, Section Prevention and Sports Medicine, Witten/Herdecke University, Faculty of Health, School of Medicine, Hagen, Germany
2 Helios Children Hospital, Witten/Herdecke University, Faculty of Health, School of Medicine, Wuppertal, Germany

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 1774
Abstract HTML Views: 603
PDF Downloads: 323
Total Views/Downloads: 2700
Unique Statistics:

Full-Text HTML Views: 822
Abstract HTML Views: 344
PDF Downloads: 238
Total Views/Downloads: 1404

Creative Commons License
© Leischik et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Priv. Doz. Roman Leischik, Elberfelder Str. 1, 58095 Hagen; Tel: 0172 2771110; Fax: 02331 182570; E-mail:



Strain echocardiography (StE) promises to be a new tool for quantitative assessment of cardiac function. Analysis of intra- and interobserver reliability is an important aspect in the process of developing these novel techniques from theory to the implementation into daily routine diagnostics.The purpose of the study was to estimate reliability of the segmental StE.


Left ventricular strain analysis for radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was performed in 21 healthy volunteers. RS and CS values were obtained in the parasternal short axis at the level of the papillary muscles. LS values were determined in the apical 2-, 3- and 4-chamber views. Cine-loops were recorded and quantitative analyses were conducted on an off-line workstation.


Intraobserver reproducibility was highest using LS in the 4-chamber view (9 ± 13.6 % mean deviation, rho = 0.624, p = 0.003), followed by CS (13.3 ± 8.3 %, rho = 0.406, p = 0.068) and lowest in RS (26.3 ± 30.1 %, rho = 0.391, p = 0.080). Interobserver analyses of LS derived from 3-chamber view showed lowest deviation (11.9 ± 9.5 %, rho = 0.513, p = 0.017), followed by CS (15.2 ± 12.0 %, 0.263, p = 0.249) and the least consistent measurements in RS (35.9 ± 46.3 %, rho 0.382, p = 0.088).


This study shows that the clinical utility of StE depends on the regional differences of LV wall motion and image quality. LS-values showed promising intra- and interobserver reproducibility values. For quantitative follow-up studies LS should be preferred.

Keywords: Interobserver-varability, intraobserver-variability, reproducibility, strain..