Inter-center reproducibility of standard and advanced echocardiographic parameters in the EACVI-AFib echo registry

Ciro Santoro, Erwan Donal, Julien Magne, Leyla Elif Sade, Martin Penicka, Asim Katbeh, Bernard Cosyns, Matteo Cameli, Jadranka Separovic Hanzevacki, Vlatka Reskovic Luksic, Eustachio Agricola, Rodolfo Citro, Andreas Hagendorff, Patrizio Lancellotti, Gilbert Habib, Antonella Moreo, Nuno Cardim, Vito Maurizio Parato, Alexsandar Neskovic, Monica RoscaElena Galli, Andreea Motoc, Giulia Mandoli, Giacomo Ingallina, Costantina Prota, Stephen Stoebe, Caroline Piette, Basile Mouhat, Andreina Carbone, Benedetta De Chiara, Federica Ilardi, Ivan Stankovic, Jose Luis Zamorano, Bogdan Alexandru Popescu, Thor Edvardsen, Maurizio Galderisi

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Aim: we sought to test the inter-center reproducibility of 16 echo laboratories involved in the EACVI-Afib Echo Europe. Methods: This was done on a dedicated setting of 10 patients with sinus rhythm (SR) and 10 with persistent atrial fibrillation (AF), collected by the Principal Investigator. Images and loops of echo-exams were stored and made available for labs. The tested measurements included main echo-Doppler parameters, global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS). Results: Single measures interclass correlation coefficients (ICCs) of left ventricular mass and ejection fraction were suboptimal in both patients with SR and AF. Among diastolic parameters, ICCs of deceleration time were poor, in particular in AF (=.50). ICCs of left atrial size and function, besides optimal in AF, showed an acceptable despite moderate concordance in SR. ICC of GLS was.81 and.78 in SR and AF respectively. ICCs of PALS were suitable but lower in 4-chamber than in 2-chamber view. By depicting the boxplot of the 16 laboratories, GLS distribution was completely homogeneous in SR, whereas GLS of AF and PALS of both SR and AF presented a limited number of outliers. GLS mean ± SE of the 16 labs was 19.7 ±.36 (95% CI: 18.8-20.4) in SR and 16.5 ±.29 (95% CI: 15.9-17.1) in AF, whereas PALS mean ± SE was 43.8 ±.70 (95% CI: 42.3-45.3) and 10.2 ±.32 (95% CI: 9.5-10.9) respectively. Conclusion: While the utilization of some standard-echo variables should be discouraged in registries, the application of GLS and PALS could be largely promoted because their superior reproducibility, even in AF.

Original languageEnglish
Pages (from-to)775-783
Number of pages9
Issue number8
Publication statusPublished - Aug 2023


  • ejection fraction
  • global longitudinal strain
  • left ventricular mass
  • peak atrial longitudinal strain
  • registry
  • reproducibility


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