Freehand three-dimensional echocardiography for measurement of left ventricular mass: in vivo anatomic validation using explanted human hearts

Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA.

OBJECTIVES: We sought to validate freehand three-dimensional echocardiography for measuring left ventricular mass and to compare its accuracy and variability with those of conventional echocardiographic methods. BACKGROUND: Accurate measurement of left ventricular mass is clinically important as a predictor of morbidity and mortality. Freehand three-dimensional echocardiography eliminates geometric assumptions used by conventional methods, minimizes image positioning errors using a line of intersection display and increases sampling of the ventricle. Preliminary studies have shown it to have high accuracy and low variability. METHODS: Twenty-eight patients awaiting heart transplantation were examined by conventional and freehand three-dimensional echocardiography. Left ventricular mass was determined by the M-mode ("Penn-cube") method, the two-dimensional truncated ellipsoid method and three-dimensional surface reconstruction. The ventricles of 20 explanted hearts were obtained, trimmed and weighed. Echocardiographic mass by each method was compared with true mass by linear regression. Accuracy, bias and interobserver variability were calculated. RESULTS: For three-dimensional echocardiography, the correlation coefficient, standard error of the estimate, root mean square percent error (accuracy), bias and interobserver variability were 0.992, 11.9 g, 4.8%, -4.9 g and 11.5%, respectively. For the two-dimensional truncated ellipsoid method they were 0.905, 38.5 g, 15.6%, 15.4 g and 23.3%. For the M-mode ("Penn-cube") method they were 0.721, 96.9 g, 53.0%, 109.2 g and 19.5%. CONCLUSIONS: Freehand three-dimensional echocardiography for measurement of left ventricular mass has high accuracy and low variability and is superior to conventional methods in hearts of abnormal size and geometry.

This article has been cited by other articles:

				M. S. Maurer, J. D. Sackner-Bernstein, L. El-Khoury Rumbarger, M. Yushak, D. L. King, and D. Burkhoff Mechanisms Underlying Improvements in Ejection Fraction With Carvedilol in Heart Failure Circ Heart Fail, May 1, 2009; 2(3): 189 - 196. [Abstract] [Full Text] [PDF]

				E. Agabiti-Rosei, M. L. Muiesan, and M. Salvetti Review: New approaches to the assessment of left ventricular hypertrophy Therapeutic Advances in Cardiovascular Disease, December 1, 2007; 1(2): 119 - 128. [Abstract] [PDF]

				M. Handke, G. Heinrichs, U. Moser, F. Hirt, F. Margadant, F. Gattiker, C. Bode, and A. Geibel Transesophageal Real-Time Three-Dimensional Echocardiography: Methods and Initial In Vitro and Human In Vivo Studies J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2070 - 2076. [Abstract] [Full Text] [PDF]

				E G Caiani, C Corsi, L Sugeng, P MacEneaney, L Weinert, V Mor-Avi, and R M Lang Improved quantification of left ventricular mass based on endocardial and epicardial surface detection with real time three dimensional echocardiography Heart, February 1, 2006; 92(2): 213 - 219. [Abstract] [Full Text] [PDF]

				V. Mor-Avi, L. Sugeng, L. Weinert, P. MacEneaney, E. G. Caiani, R. Koch, I. S. Salgo, and R. M. Lang Fast Measurement of Left Ventricular Mass With Real-Time Three-Dimensional Echocardiography: Comparison With Magnetic Resonance Imaging Circulation, September 28, 2004; 110(13): 1814 - 1818. [Abstract] [Full Text] [PDF]

				C. Jenkins, K. Bricknell, L. Hanekom, and T. H. Marwick Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography J. Am. Coll. Cardiol., August 18, 2004; 44(4): 878 - 886. [Abstract] [Full Text] [PDF]

				C. J. Francois, D. S. Fieno, S. M. Shors, and J. P. Finn Left Ventricular Mass: Manual and Automatic Segmentation of True FISP and FLASH Cine MR Images in Dogs and Pigs Radiology, February 1, 2004; 230(2): 389 - 395. [Abstract] [Full Text] [PDF]

				H. P. Kuhl, P. Hanrath, and A. Franke M-Mode Echocardiography Overestimates Left Ventricular Mass in Patients with Normal Left Ventricular Shape: A Comparative Study Using Three-Dimensional Echocardiography Eur Heart J Cardiovasc Imaging, December 1, 2003; 4(4): 313 - 319. [Abstract] [Full Text] [PDF]

				L Sugeng, L Weinert, and R M Lang Left ventricular assessment using real time three dimensional echocardiography Heart, November 1, 2003; 89(90003): iii29 - 36. [Full Text] [PDF]

				S. G. Myerson, H. E. Montgomery, M. J. World, and D. J. Pennell Left Ventricular Mass: Reliability of M-Mode and 2-Dimensional Echocardiographic Formulas Hypertension, November 1, 2002; 40(5): 673 - 678. [Abstract] [Full Text] [PDF]

				O. O. Akinboboye, R. u-L. Chou, and S. R. Bergmann Augmentation of myocardial blood flow in hypertensive heart disease by angiotensin antagonists: A comparison of lisinopril and losartan J. Am. Coll. Cardiol., August 21, 2002; 40(4): 703 - 709. [Abstract] [Full Text] [PDF]

				I. S. Salgo, J. H. Gorman III, R. C. Gorman, B. M. Jackson, F. W. Bowen, T. Plappert, M. G. St John Sutton, and L. H. Edmunds Jr Effect of Annular Shape on Leaflet Curvature in Reducing Mitral Leaflet Stress Circulation, August 6, 2002; 106(6): 711 - 717. [Abstract] [Full Text] [PDF]

				D. L. King, L. El-Khoury Coffin, and M. S. Maurer Myocardial contraction fraction: a volumetric index of myocardial shortening by freehand three-dimensional echocardiography J. Am. Coll. Cardiol., July 17, 2002; 40(2): 325 - 329. [Abstract] [Full Text] [PDF]

				C. J. Salton, M. L. Chuang, C. J. O'Donnell, M. J. Kupka, M. G. Larson, K. V. Kissinger, R. R. Edelman, D. Levy, and W. J. Manning Gender differences and normal left ventricular anatomy in an adult population free of hypertension: A cardiovascular magnetic resonance study of the Framingham Heart Study Offspring cohort J. Am. Coll. Cardiol., March 20, 2002; 39(6): 1055 - 1060. [Abstract] [Full Text] [PDF]

				S. G. Myerson, N. G. Bellenger, and D. J. Pennell Assessment of Left Ventricular Mass by Cardiovascular Magnetic Resonance Hypertension, March 1, 2002; 39(3): 750 - 755. [Abstract] [Full Text] [PDF]

				R. R. Sciacca, O. Akinboboye, R. Ling Chou, S. Epstein, and S. R. Bergmann Measurement of Myocardial Blood Flow with PET Using 1-11C-Acetate J. Nucl. Med., January 1, 2001; 42(1): 63 - 70. [Abstract] [Full Text] [PDF]

				M. L. Chuang, M. G. Hibberd, C. J. Salton, R. A. Beaudin, M. F. Riley, R. A. Parker, P. S. Douglas, and W. J. Manning Importance of imaging method over imaging modality in noninvasive determination of left ventricular volumes and ejection fraction: Assessment by two- and three-dimensional echocardiography and magnetic resonance imaging J. Am. Coll. Cardiol., February 1, 2000; 35(2): 477 - 484. [Abstract] [Full Text] [PDF]