Concordance and reproducibility between M-mode, tissue Doppler imaging, and two-dimensional strain imaging in the assessment of mitral annular displacement and velocity in patients with various heart conditions

Mitral annular (MA) displacement reflects longitudinal left ventricular (LV) deformation and systolic velocity measurements reflect the rate of contraction; both are valuable in the diagnosis and prognosis of cardiac disease. The aim of this study was to test the agreement and reproducibility between motion mode (M-mode), colour tissue Doppler imaging (TDI), and two-dimensional strain imaging (2DSI) when measuring MA displacement and systolic velocity. Using GE Healthcare Vivid 7 and E9 and Echopac BT11 software, MA displacement and velocity measurements by 2DSI, TDI, and M-mode determined in the septal and lateral walls in the apical four-chamber view were assessed in 50 control subjects and in 168 patients with various cardiac anomalies known to affect longitudinal displacement such as heart failure, mitral regurgitation, LV hypertrophy, and LV dilation. Intra- and inter-observer variability were tested using the BlandAltman method in 125 patients. A relatively low bias between M-mode and TDI with respect to MA displacement (mean difference 1.96 standard deviation: 0.08 0.35 cm) and a low bias between TDI and 2DSI with respect to MA peak systolic velocity (0.13 1.87 cm/s) were found. Reproducibility was acceptable for all methods with TDI having the lowest intra- and inter-observer variability. LV function could be assessed in terms of MA displacement and systolic velocity using M-mode, TDI, and 2DSI. None of the measurement techniques are, however, interchangeable. Overall, TDI seems to be the most robust method, having the lowest observer variability.