Repeatability of echocardiographic measurements in the human fetus

Objectives: To determine the repeatability of cross-sectional, M-mode and Doppler echocardiographic measurements in the human fetus. Methods: This was a prospective echocardiographic study of 10 normal fetuses, involving measurement of 32 different echocardiographic variables in each. The intra- and inter-observer error of measurements were quantified. The median (range) gestational age was 23 (17-34) weeks. Results: Cross-sectional echocardiography: for left ventricular end-diastolic volume the intraobserver coefficient of variation was 13% and the interobserver limits of agreement were a ratio of 0.46-2.19. For left ventricular ejection fraction the repeatability was±8.8% and the interobserver limits of agreement were±20%. M-mode echocardiography: the coefficient of variation for left ventricular end-diastolic dimension was 10%, and the interobserver limits of agreement were a ratio of 0.74-1.70. The intraobserver repeatability of left ventricular fractional shortening was±8.8%, and interobserver limits of agreement±15%. Limits of agreement for M-mode-derived left ventricular end-diastolic volume were wide, intraobserver coefficient of variation 32% and interobserver limits were a ratio of 0.44-4.36. Doppler echocardiography: the intra- and interobserver errors were high for Doppler variables such as acceleration time, acceleration slope, stroke volume, cardiac output and vessel dimension. There was less error associated with measurements such as maximum Doppler velocity, velocity time integral, ejection time and heart rate. Conclusions: The repeatability of most echocardiographic measurements in the fetus is poor. This applies particularly to volumetric data such as ventricular volumes and volume flow estimations. Interobserver errors are consistently higher than intraobserver errors, confirming that when sequential measurements are clinically important, the same observer should be used.