Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function
*Division of cardiology, Vestfold Central Hospital Toensberg, Norway
Cardiovascular Division, Hospital of the University of Pennsylvania Philadelphia, U.S.A.
Life Insurance Companies' Institute for Medical Statistics, Ullevaal Hospital Oslo, Norway
Received 26 March 1996; accepted 28 March 1996.
Correspondence: Dr Jan Erik Otterstad, MD, FESC, Division of Cardiology, Vestfold Central Hospital, N-3100 Toensberg, Norway
Abstract
OBJECTIVES: To investigate sources of variability in serial echocardiographic recordings in a core laboratory we assessed the impact of repeated echo recordings, repeated video measurements and measurements made by different investigators.
PATIENTS, METHODS: Two investigators each recorded and analysed two-dimensional echos in 12 individuals (n=24 in total) three times at one week intervals. Left ventricular end-diastolic and end-systolic volumes were measured using the biplane modified Simpson's rule. Ejection fraction was derived from these volumes and left ventricular mass estimated using the area-length method. The left ventricular spherity index was expressed as the ratio of the short axis area and the long axis area at end-diastole. A video recording from each examination was reexamined twice by both investigators.
RESULTS: Deviations between repeated echo recordings and repeated video measurements ranged from –5 to +5% between investigators. A three-way repeated analysis of variance indicated a small, but systematic difference between investigators. Reproducibility, measured by coefficients of variation, ranged from 3–9% for different investigators, 3–6% for repeated video measurements and 7–19% for repeated echo recordings across the different variables. The total variability of all three factors should be considered when the smallest detectable significant change in a variable is assessed. These ranged from 16–28% across the five variables studied, when a 10% error of classification was accepted for a one-sided change in a variable.
CONCLUSION: Repeated echo recordings were the dominant component of variation. Two-dimensional echo measurements are reproducible and accurate, but the same investigator should follow the same patients.
Key Words: Two-dimensional echocardiography • left ventricular dimensions and function • reproducibility
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