Sources and magnitude of variation of echocardiographic measurements in normal standardbred horses

The purpose of this study was to assess the intraobserver variation of various echocardiographic measures in standardbred trotters. Serial echocardiographic examinations were carried out on eight standardbred mares by one ultrasonographer for 5 separate days. During each examination, five nonconsecutive cardiac cycles (frames) were recorded and an average obtained for each individual measure. Various echocardiographic measures were obtained by use of two-dimensional (2-D), M-mode, color flow Doppler and pulsed wave Doppler echocardiography. The total variation in the echocardiographic measurements was split into three levels: the variation between horses, the day-to-day variation within individual horses, and finally the variation within horse on the same day of examination (intercardiac cycle variation). The intraclass correlation coefficient (ICC) was calculated for each measure. The ICC represents the variability of the measurements because of differences between the horses. In general the 2-D, M-mode and color flow Doppler measures had higher ICC values (ICC from 0.63 to 0.95) than the pulsed wave Doppler measures (ICC from 0.24 to 0.46), and the former measures were more repeatable than the pulsed wave measures. Exceptions to that were left ventricular free wall in diastole, the pulmonary artery in systole and the left ventricular mass, which all had low repeatability (ICC from 0.22 to 0.49). The results were used to calculate the relative differences that must be detected to diagnose a statistically significant change between two measurements in an individual horse. Differences from 4.2% to 21.8% must be achieved to document significant changes between serial measurements. A general tendency is that the color flow and pulsed wave Doppler measures require a larger relative difference (11.4-21.8%) between the measures to point out statistically significant cardiac changes than the 2-D and M-mode measures (4.2-13.9%).