ABC | Volume 110, Nº3, March 2018

Original Article Kang et al Multi-layer strain analysis in lymphoma survivors Arq Bras Cardiol. 2018; 110(3):219-228 Table 3 – Three-layer circumferential strain values between two groups stratified by levels CS-Endo(%) CS-Mid(%) CS-Epi(%) Control Chemotherapy P value Control Chemotherapy P value Control Chemotherapy p value Basal level -33.48 ± 5.10 -26.26 ± 4.34 0.000 -23.95 ± 4.26 -22.37 ± 4.28 0.149 -17.58 ± 4.03 -16.85 ± 3.93 0.453 Mid level -34.29 ± 4.21 -31.25 ± 5.39 0.014 -24.45 ± 3.46 -22.57 ± 3.67 0.053 -17.54 ± 3.21 -16.85 ± 3.94 0.063 Apical level -44.31 ± 6.14 -41.13 ± 9.47 0.038 -30.32 ± 4.46 -28.91 ± 6.34 0.316 -21.77 ± 3.95 -19.81 ± 5.39 0.105 P value 0.000 0.000 0.000 0.000 0.000 0.000 CS-ENDO: subendocardial circumferential strain; CS-EPI: subepicardial circumferential strain; CS-MID: middle circumferential strain. P values were analyzed by one way ANOVA test. Table 4 – Three-layer longitudinal strain values between two groups stratified by levels LS-Endo(%) LS-Mid(%) LS-Epi(%) Control Chemotherapy P value Control Chemotherapy P value Control Chemotherapy p value Basal level -18.51 ± 2.55 -16.82 ± 2.36 0.006 -17.74 ± 2.50 -16.49 ± 2.11 0.027 -17.07 ± 2.50 -15.63 ± 2.00 0.009 Mid level -22.76 ± 2.72 -21.04 ± 2.87 0.014 -20.82 ± 2.39 -19.45 ± 2.49 0.028 -19.23 ± 2.56 -16.87 ± 2.26 0.000 Apical level -34.36 ± 3.23 -32.29 ± 5.69 0.101 -26.20 ± 3.06 -25.08 ± 4.23 0.623 -20.8 ± 2.55 -19.53 ± 5.12 0.538 P value 0.000 0.000 0.000 0.000 0.000 0.000 LS-ENDO: subendocardial longitudinal strain; LS-EPI: subepicardial longitudinal strain; LS-MID: middle longitudinal strain. P values were analyzed by one way ANOVA test. Inter and intra-observer variation Inter-observer measurement showed ICC = 0.91 for CS‑ENDO, 0.83 for CS-MID, 0.91 for CS-EPI, 0.95 for GCS, 0.61 for RS, 0.87 for LS-ENDO, 0.85 for LS-MID, 0.90 for LS-EPI, 0.91 for GLS. Similarly, intra-observer measurement showed ICC = 0.96 for CS-ENDO, 0.89 for CS-MID, 0.97 for CS-EPI, 0.97 for GCS, 0.73 for RS, 0.86 for LS-ENDO, 0.85 for LS‑MID, 0.82 for LS-EPI, 0.94 for GLS, indicating satisfactory reproducibility by speckle-tracking-derived multilayer analysis of circumferential and longitudinal strain values. Bland-Altman curves of strain values were shown on Figure 2. Discussion Globally, cancer is diagnosed in 12.7 million people annually, with its incidence projected to increase by 40% in high-income countries from 2008 to 2030. 10 Table 5 – Strain values between two groups. Control Chemotherapy p value GLS (%) -21.86 ± 2.38 -20.36 ± 2.58 0.016* GCS (%) -27.73 ± 3.37 -24.94 ± 4.14 0.004* GRS (%) 31.44 ± 12.98 26.89 ± 9.75 0.118 LS-ENDO(%) -25.21 ± 2.72 -23.38 ± 3.11 0.014* LS-MID(%) -21.53 ± 2.36 -20.35 ± 2.58 0.029* LS-EPI(%) -18.83 ± 2.19 -17.35 ± 2.48 0.013* LS gradient (%) -6.38 ± 1.28 -6.03 ± 2.07 0.439 CS-ENDO(%) -37.37 ± 3.79 -32.88 ± 5.23 0.000* CS-MID(%) -26.24 ± 2.98 -24.62 ± 4.13 0.073 CS-EPI(%) -19.56 ± 4.45 -17.32 ± 4.13 0.066 CS gradient(%) -17.80 ± 3.69 -15.55 ± 4.59 0.0* CS-ENDO: subendocardial circumferential strain; CS-EPI: subepicardial circumferential strain; CS-MID: middle circumferential strain; GCS: global circumferential strain; GLS: global longitudinal strain; GRS: global radial strain; LS-ENDO: subendocardial longitudinal strain; LS-EPI: subepicardial longitudinal strain; LS‑MID: middle longitudinal strain. *: p < 0.05. p values were assessed by independent samples t test 222