Inter-observer variability for cardiac ultrasound measurements in cats repeated at different time points in early adult life

A high degree of accuracy is required when using echocardiography to diagnose hypertrophic cardiomyopathy (HCM) in cats, as variation in measurements of 0.5 mm may affect classification of individuals as ‘abnormal’. This study in adult cats examined at different time points inter-observer variability between two Board certified echocardiographers in veterinary cardiology. Twenty-four female European shorthair cats were examined at 12, 18 and 24 months of age by observer 1. Two dimensional (2D) echocardiographic images were collected in conscious cats to measure left ventricular, aortic and left atrial dimensions. Measurements were repeated by observer 2 on stored images, and analysed for effect of time, observer and time-observer interaction. Based on end-diastolic left ventricular wall thickness, cats were diagnosed as ‘normal’ or 'abnormal'. Linear mixed models (generalized when appropriate) were performed. A significant difference between observers was found for all septal (IVSd) and free wall (LVFWd) thickness measurements and left ventricular internal diameters but not for aortic or left atrial measurements. All measurement coefficients of variation (CV) were < 10%. The CV for IVSd was higher than the CV for LVFWd. There was a significant effect of time on IVSd, aortic measurements and left ventricular internal diameter measurements. No significant time-observer interaction was found for any parameter. Diagnosis of cats as ‘abnormal’ (>5 mm in cats > 6 kg bodyweight) was significantly different between observers for IVSd but not LVFWd. Caution is warranted when diagnosing as ‘abnormal’ or interpreting small changes based on IVSd, due to significant inter-observer differences in this measurement.