Vendor-independent software for rapid comprehensive assessment of changes in left ventricular function during serial echocardiographic studies

Sequential evaluation of left ventricular (LV) function is critical in patients receiving potentially cardiotoxic treatments. However, identification and interpretation of the clinical significance of subtle changes in LV function from echocardiographic images is time-consuming and requires training. The aim of this study was to develop and test a new approach aimed at addressing this issue. Dedicated semi-automated software was developed (Epsilon Imaging), which analyzes images obtained during serial examinations and provides a visual, easy-to-understand display of changes in LV ejection fraction (EF), peak systolic global longitudinal strain (GLS) or both. To test this software, 30 subjects who had 2 echocardiographic studies separated by ≥4 weeks were identified and their images analyzed. An expert echocardiographer reviewed EF and GLS data separately using commercial software (Philips QLab), and classified EF and/or GLS in each patient as unchanged, improved or worsened. This classification was used as a reference to test the accuracy of using a combined display of changes in EF and GLS. This was performed by an inexperienced observer with and then without the dedicated software. Image analysis and interpretation were faster using the dedicated software (27±5 vs 15±5 minutes). The agreement with the reference was slightly better with the software (93%; kappa=0.90) than without it (90%; kappa=0.87). Combined displays of changes in EF and GLS data from serial studies allows quick, easy and accurate interpretation of changes in LV function, promising to improve follow-up of patients undergoing potentially cardiotoxic treatments such as chemotherapy.