Comparison of Accurate Measurement of Left Ventricular Mass in Patients With Hypertrophied Hearts by Real-Time Three-Dimensional Echocardiography Versus Magnetic Resonance Imaging

doi:10.1016/j.amjcard.2005.01.065

The American Journal of Cardiology

Volume 95, Issue 10, 15 May 2005, Pages 1263-1267

https://doi.org/10.1016/j.amjcard.2005.01.065 Get rights and content

To evaluate whether left ventricular (LV) mass assessed by a new real-time, 3-dimensional echocardiographic (RT-3DE) system corresponds to cardiac magnetic resonance imaging (MRI) in patients with LV hypertrophy, RT-3DE and 2-dimensional echocardiography (2DE) were performed to calculate LV mass in 21 patients (mean age 54 ± 15 years) who underwent MRI for the evaluation of LV hypertrophy. In 20 of 21 patients, adequate 3-dimensional data for LV mass analysis were obtained, and regression analysis showed that LV mass by RT-3DE correlated with that determined by MRI (r = 0.95, y = 28.9 + 0.85x) better than with that determined by 2DE (r = 0.70, y = 43.6 + 0.81x). RT-3DE allows the accurate measurement of LV mass in patients with hypertrophied hearts.

Section snippets

Acknowledgment

We gratefully acknowledge Masayasu Motoduka, Mitsuji Higashida, and Masaru Yamazaki, the radiologic technicians, for their assistance in the recording of cardiac MRI in the present study.

References (9)

K. Arai et al.
Accuracy of measurement of left ventricular volume and ejection fraction by new real-time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction
Am J Cardiol
(2004)
S.H. Park et al.
Two-dimensional echocardiographic calculation of left ventricular mass as recommended by the American Society of Echocardiography: correlation with autopsy and M-mode echocardiography
J Am Soc Echocardiogr
(1996)
J. Scharhag et al.
Athlete's heartRight and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging
J Am Coll Cardiol
(2002)
H.P. Kühl et al.
High-resolution transthoracic real-time three-dimensional echocardiography
J Am Coll Cardiol
(2004)

There are more references available in the full text version of this article.

Cited by (56)

Diabetes Mellitus
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection Fraction
Heart failure is common in diabetics. Diabetes mellitus dramatically increases heart failure, where diastolic dysfunction is one of the early manifestations. Hyperglycemia and insulin resistance are key mechanisms in the development of diabetic cardiomyopathy. It begins insidiously especially in the early stage, and symptoms generally start to develop in the middle and late stages. Diastolic dysfunction (E/e′ > 15) is associated with a poor prognosis among them. Diastolic stress test should be considered for the investigation of unprovoked dyspnea with the diabetic patient. This chapter also summarizes medication management, as not all antidiabetic medications have favorable prognostic effects.
Aging Changes Seen On Echocardiography
2016, Practice of Clinical Echocardiography
Comparison of three-dimensional echocardiographic findings to those of magnetic resonance imaging for determination of left ventricular mass in patients with ischemic and non-ischemic cardiomyopathy
2013, American Journal of Cardiology
Citation Excerpt :
A net reclassification index was calculated for comparison of measurements.26 The sample size calculation was based on the assumption that the r value of the correlation for LV mass between CMR and 3DE should have a minimum value of 0.82, according to previous studies.8–20 The minimum sample size in each group was calculated to be 18 (power 0.90).
The standard echocardiographic evaluation of left ventricular (LV) mass, particularly in ischemic cardiomyopathy (IC) is challenging because it is based on geometric assumptions. The aim of this study was to assess the accuracy of LV mass calculation using echocardiographic modalities compared with cardiac magnetic resonance (CMR) in IC and in nonischemic cardiomyopathy (non-IC). Echocardiography was performed in 104 patients (mean age 55 ± 15 years) referred for CMR: 63 with IC and 41 with non-IC. CMR, M-mode echocardiography, 2-dimensional echocardiography, and 3-dimensional echocardiography (3DE) were analyzed using standard commercial tools to obtain LV mass. LV mass on 3DE showed a higher correlation with CMR than 2-dimensional echocardiography (r = 0.87 vs r = 0.70, p <0.001). M-mode echocardiography overestimated LV mass (bias +30%) and 2-dimensional echocardiography underestimated LV mass (bias −11%), whereas measurements on 3DE showed only minimal bias (−2%). LV mass on 3DE in non-IC showed a significantly higher correlation with CMR than in IC (r = 0.92 vs r = 0.84, z = 2.3, p <0.05). In non-IC, the mean difference was −2 g (−1% of the mean), with 95% limits of agreement of ±33 g (±19% of the mean). In IC, the mean difference was −7 g (−4% of the mean), with limits of agreement of ±56 g (±31% of the mean). There was a correlation between the absolute LV mass differences (3DE derived and CMR derived) and scar percentage (infarcted mass/total LV mass) using delayed-hyperenhancement images (r = 0.40, p <0.05). The net reclassification index with 3DE was +16% for concentric LV hypertrophy. In conclusion, the most accurate and reliable echocardiographic measurement of LV mass is 3DE, but underestimation and variability remain challenges in IC.
Assessment of left ventricular mass in hypertrophic cardiomyopathy by real-time three-dimensional echocardiography using single-beat capture image
2013, Journal of the American Society of Echocardiography
Citation Excerpt :
Furthermore, the CMR method for LV mass assessment is based on the summation of 2D image stacks, but there are gaps between imaging planes, and thus 3D echocardiography may be more accurate in vivo than CMR for determining LV myocardial mass. Multiple-beat RT3DE imaging has already been shown to significantly improve accuracy in LV mass quantification in comparison with 2D approaches, with CMR as a reference, irrespective of geometric assumptions or using manual adjustment for accurate delineation of endocardial and epicardial borders.14-19 These studies included about 20 patients and acquired RT3DE images with four wedged subvolumes and analyzed them offline.
Left ventricular (LV) mass is an important prognostic indicator in hypertrophic cardiomyopathy. Although LV mass can be easily calculated using conventional echocardiography, it is based on geometric assumptions and has inherent limitations in asymmetric left ventricles. Real-time three-dimensional echocardiographic (RT3DE) imaging with single-beat capture provides an opportunity for the accurate estimation of LV mass. The aim of this study was to validate this new technique for LV mass measurement in patients with hypertrophic cardiomyopathy.
Sixty-nine patients with adequate two-dimensional (2D) and three-dimensional echocardiographic image quality underwent cardiac magnetic resonance (CMR) imaging and echocardiography on the same day. Real-time three-dimensional echocardiographic images were acquired using an Acuson SC2000 system, and CMR-determined LV mass was considered the reference standard. Left ventricular mass was derived using the formula of the American Society of Echocardiography (M-mode mass), the 2D-based truncated ellipsoid method (2D mass), and the RT3DE technique (RT3DE mass).
The mean time for RT3DE analysis was 5.85 ± 1.81 min. Intraclass correlation analysis showed a close relationship between RT3DE and CMR LV mass (r = 0.86, P < .0001). However, LV mass by the M-mode or 2D technique showed a smaller intraclass correlation coefficient compared with CMR-determined mass (r = 0.48, P = .01, and r = 0.71, P < .001, respectively). Bland-Altman analysis showed reasonable limits of agreement between LV mass by RT3DE imaging and by CMR, with a smaller positive bias (19.5 g [9.1%]) compared with that by the M-mode and 2D methods (−35.1 g [−20.2%] and 30.6 g [17.6%], respectively).
RT3DE measurement of LV mass using the single-beat capture technique is practical and more accurate than 2D or M-mode LV mass in patients with hypertrophic cardiomyopathy.
Quantitation of cardiac chamber geometry and function using transthoracic three-dimensional echocardiography
2012, Journal of Cardiovascular Echography
Quantification of cardiac chambers size, geometry and function represent the most frequent indications for an echocardiographic study and are pivotal for patient evaluation and management.
Three-dimensional echocardiography (3DE) enables an easier, more accurate and reproducible interpretation of the complex geometry of cardiac chambers, overcoming the intrinsic limitations of conventional two-dimensional echocardiography (2DE). One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. This feature render the technique feasible and reliable even in patients with asymmetric or distorted cardiac chambers, paradoxically the subjects in whom an accurate quantification is most needed.
The purpose of this review is to analyze the role of 3DE in chamber quantification, emphasizing the incremental benefits of 3DE over conventional 2DE.
L’analisi quantitativa delle dimensioni, della forma e della funzione delle camere cardiache rappresenta la più frequente indicazione ad un esame ecocardiografico ed è cruciale per il corretto inquadramento clinico ed il successivo trattamento del paziente. L’ecocardiografia tridimensionale (3DE) consente una più facile, accurata e riproducibile valutazione della complessa geometria delle camere cardiache superando le intrinsiche limitazioni della ecocardiografia bidimensionale (2D). Uno dei maggiori vantaggi del 3DE è l’accuratezza con cui vengono misurati i volumi delle camere cardiache evitando gli errori dovuti alle assunzioni geometriche circa la forma della cavità ed il possibile accorciamento arti fattuale delle sezioni inerenti alla metodica 2D. Queste caratteristiche rendono il 3D una metodica fattibile ed affidabile anche in ventricoli asimmetrici o con geometria distorta, che paradossalmente sono proprio coloro in cui un’accurata valutazione sarebbe maggiormente utile.
Lo scopo di questa rassegna è quello di analizzare il ruolo del 3DE nella quantizzazione delle camere cardiache mettendo in evidenza i benefici incrementali del 3DE sul 2DE.
Meta-analysis of accuracy of left ventricular mass measurement by three-dimensional echocardiography
2012, American Journal of Cardiology
Left ventricular (LV) hypertrophy is a fundamental prognostic factor in a variety of cardiac diseases. Three-dimensional echocardiography (3DE) has achieved better estimation of LV mass than 2-dimensional echocardiography. However, significant underestimation has often been reported, and no previous study has synthesized these data. The aim of this meta-analysis was to investigate if there has been improvement in the accuracy in LV mass measurement by 3DE over time. Studies comparing LV mass between 3DE and magnetic resonance imaging were eligible. A cumulative meta-analysis was performed to investigate improvement in accuracy, followed by subgroup and meta-regression analysis to reveal factors affecting the bias. A total of 25 studies including 671 comparisons were analyzed. Studies published in or before 2004 showed high heterogeneity (I² = 69%) and significant underestimation of LV mass by 3DE (−5.7 g, 95% confidence interval −11.3 to −0.2, p = 0.04). Studies published from 2005 to 2007 were still heterogenous (I² = 60%) but showed less systematic bias (−0.5 g, 95% confidence interval −2.5 to 1.5, p = 0.63). In contrast, studies published in or after 2008 were highly homogenous (I² = 3%) and showed excellent accuracy (−0.1 g, 95% confidence interval −2.2 to 1.9, p = 0.90). Investigation of factors affecting the bias revealed that evaluation of cardiac patients compared to healthy volunteers led to larger bias (p <0.05). In conclusion, this meta-analysis elucidates the underestimation of LV mass by 3DE, its improvement over the past decade, and factors affecting the bias. These data provide a more detailed basis for improving the accuracy of 3DE, an indispensable step toward further clinical application.

View all citing articles on Scopus

View full text

Brief reportComparison of Accurate Measurement of Left Ventricular Mass in Patients With Hypertrophied Hearts by Real-Time Three-Dimensional Echocardiography Versus Magnetic Resonance Imaging

Section snippets

Acknowledgment

Am J Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Coll Cardiol

Brief report
Comparison of Accurate Measurement of Left Ventricular Mass in Patients With Hypertrophied Hearts by Real-Time Three-Dimensional Echocardiography Versus Magnetic Resonance Imaging