Methodological approach for the assessment of ultrasound reproducibility of cardiac structure and function: a proposal of the study group of Echocardiography of the Italian Society of Cardiology (Ultra Cardia SIC) Part I

Abstract

When applying echo-Doppler imaging for either clinical or research purposes it is very important to select the most adequate modality/technology and choose the most reliable and reproducible measurements. Quality control is a mainstay to reduce variability among institutions and operators and must be obtained by using appropriate procedures for data acquisition, storage and interpretation of echo-Doppler data. This goal can be achieved by employing an echo core laboratory (ECL), with the responsibility for standardizing image acquisition processes (performed at the peripheral echo-labs) and analysis (by monitoring and optimizing the internal intra- and inter-reader variability of measurements). Accordingly, the Working Group of Echocardiography of the Italian Society of Cardiology decided to design standardized procedures for imaging acquisition in peripheral laboratories and reading procedures and to propose a methodological approach to assess the reproducibility of echo-Doppler parameters of cardiac structure and function by using both standard and advanced technologies. A number of cardiologists experienced in cardiac ultrasound was involved to set up an ECL available for future studies involving complex imaging or including echo-Doppler measures as primary or secondary efficacy or safety end-points. The present manuscript describes the methodology of the procedures (imaging acquisition and measurement reading) and provides the documentation of the work done so far to test the reproducibility of the different echo-Doppler modalities (standard and advanced). These procedures can be suggested for utilization also in non referall echocardiographic laboratories as an "inside" quality check, with the aim at optimizing clinical consistency of echo-Doppler data.

Effect of Echocardiographic Grading of Left Ventricular Diastolic Dysfunction by Different Classifications in Primary Care

“…Studies were prospectively performed by 3 independent, board-certified cardiologist, with >15 years of clinical experience in performing and interpreting echocardiographic examinations, using commercially available ultrasound systems, according to a predetermined protocol. 11 LV size and function were assessed according to the American Society of Echocardiography/European Association of Echocardiography (ASE/ EAE) recommendations. 12 All the indexes for assessing diastolic function were measured from the apical views.…”

Impact of pulse pressure on left ventricular global longitudinal strain in normotensive and newly diagnosed, untreated hypertensive patients

“…Transmitral Doppler inflow and pulsed Tissue Doppler were recorded in apical four-chamber view. The average of the peak early systolic (s') and diastolic velocity (e') of the septal and lateral mitral annulus velocities were calculated and the ratio of transmitral peak early velocity (E) to average e' (E/e' ratio) derived as an estimate of left ventricular filling pressure [22,23,28]. All Doppler measurements were averaged from three cardiac cycles.…”

“…Two-dimensional (2D) and Doppler exam were performed according to the standards of our laboratory [22,23]. The quantitative analysis of the left ventricle was done in agreement of 2015 ASE/EACVI recommendations [24].…”

“…STE procedures were performed according to the standard of our laboratory [23]. STE of the left ventricle was recorded on 2D images of three consecutive cardiac cycles from the three apical views (long axis, four-and twochamber) at an approximately equal heart rate.…”

Regression of Left Ventricular Mass after Implantation of the Sutureless 3f Enable Aortic Bioprosthesis

“…14,15 With that goal in mind, we established an echocardiographic laboratory at our institution (Fondazione Toscana G. Monasterio, Massa), in order to ensure the best data quality by standardizing image acquisition and minimizing the variability of measurements. Dedicated cardiologists and sonographers have been trained, in accordance with current guidelines, to obtain reproducible Doppler echocardiographic measurements of cardiac structure and function.…”