Related Experiment Video
Updated: Aug 23, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Serial echocardiographic assessment of left ventricular mass: how blinded should readers be?
Philippe Gosse1, Giovanni de Simone, Olivier Dubourg
1Service de Cardiologie -- Hypertension Artérielle, Groupe Hospitalier Saint André, Bordeaux, France. philippe.gosse@chu-bordeaux.fr
Insights
Analyzing echocardiograms together in a blinded review significantly reduces measurement variability. This
Area of Science:
- Cardiology
- Clinical Trials
- Medical Imaging
Background:
- Left ventricular (LV) hypertrophy is a key indicator in hypertensive patients.
- Accurate measurement of LV mass (LVM) is crucial for assessing treatment efficacy.
- Central blinded review of echocardiograms aims to reduce measurement variability.
Purpose of the Study:
- To evaluate the effect of group-analysis of echocardiograms on measurement variability.
- To compare the impact of individual serial versus simultaneous group-analysis on LVM change.
- To determine the optimal methodology for central blinded review in clinical trials.
Main Methods:
- 630 echocardiograms from 210 hypertensive patients were analyzed.
- Three echocardiograms per patient (baseline, W0, W52) were read twice using two methods.
- Method 1: Individual serial echocardiogram review. Method 2: Simultaneous group-analysis of all echocardiograms per patient (blinded sequence).
Main Results:
- Simultaneous group-analysis reduced LVM change variability by 22% compared to individual review.
- Despite good agreement in LVM values, LVM change under treatment was reduced by 41% with group-analysis.
- This indicates that pooling echocardiograms enhances the detection of treatment effects.
Conclusions:
- The 'full-blind' methodology, involving simultaneous group-analysis, maximizes study power.
- This approach can lead to a reduced sample size in clinical trials.
- This optimized review process improves the efficiency of assessing antihypertensive treatments.
Objectives:
In addition to the interest of mixing the sequence of echo-exam in a central blinded review, we studied the effect that might result from group-analysis of all echocardiograms simultaneously for each patient, with their sequence kept blind. A priori, this method of reading has the potential of decreasing measurement variability.
Methods:
We included 630 echocardiograms from 210 hypertensive patients participating in a randomized clinical trial comparing two antihypertensive agents for regression of left ventricular (LV) hypertrophy. Three echocardiograms per patient [selection (4 weeks before; W-4), at inclusion (week 0; W0), and the end of treatment (week 52; W52)], were read twice, according to two methods, blind to centre, patient numbers and sequence of visits: (1) examination of individual serial echocardiograms, (2) examination of all-patient mixed echocardiograms. The first method was expected to increase the power of treatment comparison by reducing variability of measurements of left ventricular mass (LVM).
Results:
Pooling echocardiograms of all patients reduces variability of LVM change under treatment: absolute LVM (W52 - W0) standard deviation was reduced by 22%. Nevertheless, despite a good between-methods agreement for LVM values at each visit (intra-class coefficient of correlation from 0.88 to 0.92), LVM change under treatment was reduced even more, by 41%. Thus, the slight decrease of variability induced by gathering the echocardiograms is associated with an even greater reduction of LVM change.
Conclusions:
According to these findings, the 'full-blind' methodology for a central blinded review in clinical trials appears to produce the maximum power of the study with the lowest sample size.
