Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function

Eur Heart J. 1997 Mar;18(3):507-13. doi: 10.1093/oxfordjournals.eurheartj.a015273.


Objective: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Echocardiography / methods*
  • Echocardiography / statistics & numerical data
  • Female
  • Humans
  • Hypertrophy, Left Ventricular / diagnostic imaging*
  • Male
  • Myocardial Infarction / diagnostic imaging
  • Observer Variation
  • Prospective Studies
  • Reproducibility of Results
  • Stroke Volume / physiology
  • Ventricular Function, Left / physiology*