Standards Defining Echocardiography Core Laboratory (ECL) in Clinical Practice and Research.

Echocardiography is extensively utilized in both clinical practice and research due to its accessibility. Echocardiography core laboratories (ECLs) adhering to societal guidelines offer superior readings and interpretations compared with the on-site assessments by reducing measurement variability and enhancing study precision. In the present work, we aim to define minimum standards for clinical echocardiography laboratories and research ECLs based on recommendations from the American Society of Echocardiography and the European Association of Cardiovascular Imaging, as well as on expert opinion and our experience in European countries. Accurate acquisition of high-quality images is crucial for ensuring reproducibility, repeatability and reliability of the echocardiographic measurements. In addition to the commonly used workstations, an academic ECL must also possess the necessary capacities and skilled personnel to conduct sophisticated research projects. Personnel should hold advanced certification in echocardiography, indicating postgraduate training and experience beyond the basic cardiovascular ultrasound education. They should be capable of designing, performing, and interpreting complex echocardiography studies. Reproducibility of the ECL should be validated using a small, randomly selected sample, preferably in the early analytic phase. ECL readings and interpretations are superior to site-reported measurements and serve as the gold standard in observational studies and clinical trials. To ensure internal validity, an academic ECL should continuously evaluate/report reproducibility, repeatability and reliability. ECL should be formally acknowledged and accredited by an international scientific imaging society.