Left and right ventricular strain–volume/area loops: an evaluation of intra-observer, inter-observer and test–retest reliability

Donker, SCM ORCID: 0000-0002-8019-8699, Maxwell, JD, Haibe, HJ, Verhoeven, ECC, Kerstens, TP, Buckley, BJR ORCID: 0000-0002-1479-8872, Thijssen, DHJ ORCID: 0000-0002-7707-5567 and Oxborough, D ORCID: 0000-0002-1334-3286 Left and right ventricular strain–volume/area loops: an evaluation of intra-observer, inter-observer and test–retest reliability. European Heart Journal. Imaging Methods and Practice. ISSN 2755-9637 (Accepted)

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Abstract

INTRODUCTION
Recent studies highlight that left (LV) and right ventricular (RV) strain–volume/area interactions, particularly systolic slope and coupling parameters, carry clinical and physiological relevance. This study evaluated the intra-observer, inter-observer and test–retest reliability of echocardiographic LV and RV strain–volume/area loops.

METHODS
29 healthy adults underwent two transthoracic echocardiograms two hours apart after standardized preparation. One observer analysed the first scan twice (intra-observer reliability) and the second scan once (test–retest reliability). A second observer analysed the first scan once (inter-observer reliability). Observers were blinded and analysed data independently. Reliability was assessed for systolic (systolic slope (SS), peak strain (PS)) and coupling parameters (early (EarlyU) and late diastolic uncoupling (LateU)), using intraclass correlation coefficients (ICCs) and Bland–Altman analyses.

RESULTS
ICCs were generally higher for LV strain–volume than for RV strain–area loops. For LV, intra-/inter-observer and test–retest reliability was good-to-excellent for SS (ICCs: 0.84–0.92), moderate-to-good for PS and EarlyU (ICCs: 0.64–0.85 and 0.60–0.87, respectively), and poor-to-good for LateU (ICCs: 0.48–0.78). For RV, reliability was good for SS (ICCs: 0.78–0.89), poor-to-moderate for PS (ICCs: 0.19–0.59), moderate for EarlyU and LateU (ICCs: 0.53–0.68, and 0.60–0.73, respectively). Systematic bias was minimal.

CONCLUSION
Reliability was superior for LV-based parameters compared to RV. Both the LV and RV loops showed moderate-to-excellent reliability for SS and EarlyU, whilst reliability for PS and LateU varied from poor-to-good. These findings provide a methodological basis for future studies applying strain–volume and strain–area loops.

Item Type:	Article
Subjects:	Q Science > QP Physiology R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Oxford University Press
Date of acceptance:	13 April 2026
Date of first compliant Open Access:	17 April 2026
Date Deposited:	17 Apr 2026 14:52
Last Modified:	17 Apr 2026 14:52
DOI or ID number:	10.1093/ehjimp/qyag069
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28393

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