Interpretation of echocardiographic measurements: A call for standardization

Background Although echocardiography is used extensively in clinical medici ne, guidelines for quantitative interpretation of echocardiographic measure ments are unavailable. The goals of this investigation were to provide an o verview of scientific standards for formulating reference values, with clin ical chemistry used as a model, to evaluate published echocardiographic ref erence limits, to survey clinical echocardiography laboratories regarding t heir interpretation of echocardiographic measurements, and to provide recom mendations for improving the interpretation and reporting of echocardiograp hic measurements. Methods and Results We reviewed the original reports of the international F ederation of Clinical Chemistry on guidelines for formulating reference val ves. We obtained published reports on echocardiographic reference limits th rough searches of electronic databases supplemented by a manual search of r elevant bibliographies. We also surveyed echocardiographic laboratories in 35 adult acute-care hospitals in Eastern Massachusetts. Studies on echocard iographic reference values were evaluated with the use of guidelines from c linical chemistry. Responses from the 29 participating echocardiographic la boratories were evaluated for their practice of quantitative echocardiograp hic interpretation. There is considerable heterogeneity in the echocardiogr aphic reference values available in the literature. There is also a lack of agreement in the literature and among echocardiographers regarding the par titioning of reference values (by sex, ethnicity, or age), the anthropometr ic measure to be used for indexation, and the choice of cut-points for cate gorizing values within the abnormal range. Conclusions We advocate that echocardiographic reference limits be standard ized and a consensus generated regarding the partitioning of reference limi ts and the indexation of echocardiographic measurements, Such measures can aid in quantitative echocardiographic interpretation and render the results more scientific and consistent.