Circulation, Vol 58, 1072-1083, Copyright © 1978 by American Heart Association
DJ Sahn, A DeMaria, J Kisslo and A Weyman
Four hundred M-mode echocardiographic surveys were distributed to determine
interobserver variability in M-mode echocardiographic measurements. This
was done with a view toward examining the need and determining the criteria
for standardization of measurement. Each survey consisted of five M-mode
echocardiograms with a calibration marker, measured by the survey
participants anonymously. The echoes were judged of adequate quality for
measurement of structures. Seventy- six of the 400 (19%) were returned,
allowing comparison of interobserver variability as well as examination of
the measurement criteria which were used. Mean measurements and percent
uncertainty were derived for each structure for each criterion of
measurement. For example, for the aorta, 33% of examiners measured the
aorta as an outer/inner or leading edge dimension, and 20% measured it as
an outer/outer dimension. The percent uncertainty for the measurement (1.97
SD divided by the mean) showed a mean of 13.8% for the 25 packets of five
echoes measured using the former criteria and 24.2% using the latter
criteria. For ventricular chamber and cavity measurements, almost one-half
of the examiners used the peak of the QRS and one-half of the examiners
used the onset of the QRS for determining end- diastole. Estimates of the
percent of measurement uncertainty for the septum, posterior wall and left
ventricular cavity dimension in this study were 10--25%. They were much
higher (40--70%) for the right ventricular cavity and right ventricular
anterior wall. The survey shows significant interobserver and
interlaboratory variation in measurement when examining the same echoes and
indicates a need for ongoing education, quality control and standardization
of measurement criteria. Recommendations for new criteria for measurement
of M-mode echocardiograms are offered.
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Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements
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