Routine echocardiographic measurements in clinical practice: reproducibility of left and right ventricular indices and agreement with cardiac magnetic resonance

Abstract

Background Although the reproducibility of individual echocardiographic measurements has been previously investigated, evidence evaluating a comprehensive panel of routinely used left- and right-sided parameters within standardized real-world clinical workflows from Latin American centers remains limited. We aimed to evaluate the reproducibility of routine echocardiographic measurements, including intraobserver and interobserver variability, and to examine their agreement with cardiac magnetic resonance (CMR). Methods Two cohorts of adult participants were included between 2022 and 2023: a clinical cohort consisting of patients referred for transthoracic echocardiography because of cardiovascular symptoms or routine cardiovascular evaluation, and a healthy reference group with no history of cardiovascular disease or self-reported systemic illness. Left- and right-sided echocardiographic measurements, including ventricular, atrial, and left ventricular outflow tract (LVOT) indices, were analyzed. CMR was used to assess left ventricular volumes and ejection fraction. Reproducibility was assessed by two echocardiographers using intraclass correlation coefficients and Bland–Altman analysis. Results Sixty-three participants were included, 20 in the healthy reference group and 43 in the clinical cohort. Left ventricular measurements showed excellent reproducibility, whereas right-sided indices showed overall good reproducibility. LVOT diameter showed the lowest concordance. Compared with CMR, echocardiography underestimated left ventricular volumes, while agreement for left ventricular ejection fraction remained excellent. Conclusions In routine clinical practice, standard echocardiographic measurements showed overall good reproducibility, with the strongest performance for left ventricular indices. Greater variability was observed for selected right ventricular measurements and LVOT diameter, whereas agreement with CMR was excellent for left ventricular ejection fraction despite underestimation of ventricular volumes.