To the Editor: We read with interest the article by Sen et al. in the current issue of JASE,1 “Prognostic Signals From Moderate Valve Disease in Big Data: An Artefact of Digital Imaging and Communications in Medicine Structured Reporting?,” along with the accompanying editorial, “Echoing Errors: The Problem of Uncurated ‘Big Data’ in Echocardiography.”2 We note the major concern that “big echo data” is beset by bias, resulting in “rubbish in, rubbish out.” This is of paramount importance given that the National Echo Database of Australia (NEDA) has produced potentially paradigm-changing observations around the prognostic impact of moderate aortic stenosis (AS),3 results subsequently verified by others.