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J Am Coll Cardiol, 1999; 34:1625-1632
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Reliability of echocardiographic assessment of left ventricular structure and function

The PRESERVE study

Vittorio Palmieri, MDa, Björn Dahlöf, MD, PhD*, Vincent DeQuattro, MD, FACC{dagger}, Norman Sharpe, MD, FACC{ddagger}, Jonathan N. Bella, MDa, Giovanni de Simone, MD, FACCa, Mary Paranicas, BAa, Dawn Fishman, BAa and Richard B. Devereux, MD, FACCa

a Division of Cardiology, The New York Hospital–Weill Medical College of Cornell University, New York, New York, USA
* University of Goteborg, Goteborg, Sweden
{dagger} Los Angeles County/U.S.C. Medical Center, The White Memorial Medical Center, Los Angeles, California, USA
{ddagger} Department of Medicine, Auckland Hospital, Auckland, New Zealand

Manuscript received October 21, 1998; revised manuscript received May 18, 1999, accepted July 19, 1999.

Reprint requests and correspondence to: Richard B. Devereux, Division of Cardiology, Box 222, New York–Presbyterian Hospital–Weill Medical College of Cornell University, 525 E. 68 Street, New York, New York 10021
rbdevere{at}mail.med.cornell.edu

OBJECTIVES

The study was done to evaluate reliability of echocardiographic left ventricular (LV) mass.

BACKGROUND

Echocardiographic estimation of LV mass is affected by several sources of variability.

METHODS

We assessed intrapatient reliability of LV mass measurements in 183 hypertensive patients (68% men, 65 ± 9 years) enrolled in the Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) trial after a screening echocardiogram (ECHO) showed LV hypertrophy. A second ECHO was repeated at randomization (45 ± 25 days later). Two-dimensional (2D)-guided M-mode or 2D linear measurements of LV cavity and wall dimensions were verified by one experienced reader.

RESULTS

Mean LV mass was similar at first and second ECHO (243 ± 53 vs. 241 ± 54 g) and showed high reliability as estimated by intraclass correlation coefficient (RHO) = 0.93. Within-patient 5th, 10th, 90th and 95th percentiles of between-study difference in LV mass were –32 g, –28 g, +25 g and +35 g. Mean LV mass fell less from the first to the second ECHO than expected from a formula to predict regression to the mean (2 ± 19 vs. 17 ± 12 g, p < 0.001). Reliability was also high for LV internal diameter (RHO = 0.87), septal (RHO = 0.85) and posterior wall thickness (RHO = 0.83). Substantial or moderate reliability was observed for measures of LV systolic function and diastolic filling (RHO from 0.71 to 0.57).

CONCLUSIONS

Left ventricular mass had high reliability and little regression to the mean; between-study LV mass change of ±35 g or ±17 g had ≥95% or ≥80% likelihood of being true change.

Abbreviations and Acronyms
  BMI = body mass index
  BP = blood pressure
  BSA = body surface area
  c-FS = stress-corrected fractional shortening
  c-MWS = stress-corrected midwall shortening
  ESS = end-systolic stress
  FS = fractional shortening
  LV = left ventricular
  MSb = between-subject mean square of variance
  MSw = within-subject mean square of variance
  MWS = midwall shortening
  PRESERVE = Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement
  RHO = intraclass correlation coefficient




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