Evaluating the performance of automatic wave speed estimators of natural shear waves to assess myocardial stiffness

Cardiac Shear Wave Elastography is an emerging non-invasive technique using ultrafast echocardiographic imaging. Natural shear waves (SW) occur after mitral valve closure (MVC) and aortic valve closure (AVC), and their propagation velocities are directly related to myocardial stiffness. However, the current assessment of SW velocities lacks a gold standard method, and relies on manual measurements with their inherent variability.

To explore new automated methods for shear wave velocity estimates, aiming to achieve greater accuracy, less variability, and high feasibility.

To visualize shear waves, anatomical M-modes were drawn (4±1 cm) along ventricular septum in parasternal long axis views (PLAX), acquired with high-frame-rate echocardiography (1055±159 Hz). M-modes were colour coded for tissue acceleration. SWs appear as tilted green bands after MVC & AVC, the slope of which represents the SW propagation velocity. One hundred-twenty different slopes from healthy volunteers (n=67) and patients (n=53) were measured manually and with 9 different automatic methods. All automatic methods were initiated by indicating the approximate position of the shear wave in the M-mode with a mouse click of the user. Measurements were repeated three times to assess measurement reproducibility. (figure 1, A). In order to determine the influence of display settings, three different acceleration colour scales were tested (0.5, 1, 2 m/s²). (Figure 1, B). Failure of correctly identifying shear waves was counted to assess feasibility. Due to the lack of a gold standard, manual measurements of an experienced reader served as reference.

Three of nine automatic methods: Radon Transformation (RT), Regression Segmentation Maximum value (RM), Regression Segmentation Weighted Maximum (RMW), revealed the least variability with repeated measurements (0.0±0.0 m/s for all) and colour scales (0.0±0.0, 0.1±0.2 and 0.1±0.2 m/s, resp.). Those three methods showed moderate to good agreement (r=0.66, ICC 0.77 [CI 0.64- 0.85]; r= 0.67, ICC 0.75 [CI 0.50 -0.86]; and r= 0.77, ICC 0.85 [CI 0.73-0.90], resp.) with manual measurements (r=0.96, ICC 0.98 [CI 0.97- 0.99] (figure 2).

RT, RM, and RMW showed a good reproducibility while RMW showed the best agreement with manual measurements. Our data suggest, that the RMW method could offer an objective alternative for SW velocity estimations. Further research is needed to explore their applicability in clinical scenarios.