Measurement of Left Ventricular Mass by Real-Time Three-Dimensional Echocardiography: Validation Against Magnetic Resonance and Comparison with Two-Dimensional and M-Mode Measurements

doi:10.1016/j.echo.2008.07.008

Journal of the American Society of Echocardiography

Volume 21, Issue 9, September 2008, Pages 1001-1005

https://doi.org/10.1016/j.echo.2008.07.008 Get rights and content

Background

The recent development of 3-dimensional (3D) surface detection algorithm of the endocardial and epicardial surfaces from real-time 3D echocardiographic (RT3DE) datasets allows direct semiautomated quantification of left ventricular mass (LVM). Our aims were to (1) evaluate the accuracy of RT3DE measurements of LVM using this algorithm against cardiac magnetic resonance (CMR) reference and (2) compare RT3DE LVM with conventional M-mode, 2-dimensional (2D), and RT3DE-guided biplane measurements.

Methods

A total of 205 patients were studied in 2 protocols: (1) RT3DE and CMR imaging was performed on the same day in 55 subjects; (2) in an additional 150 subjects, RT3DE, 2D, and M-mode images were acquired. In both protocols, RT3DE endocardial and epicardial surfaces were semiautomatically identified at end diastole (QLab, Philips Medical Systems, Andover, MA) to calculate LVM. CMR, 2D, and M-mode–derived LVM were obtained using standard techniques.

Results

A significant correlation (r = 0.95) was noted between RT3DE and CMR-derived LVM with a small bias of −2 g. M-mode–derived LVM measurements (175 ± 64 g) were significantly larger than RT3DE LVM (123 ± 39 g, bias: 52 g) with moderate correlation (r = 0.76). No significant differences in LVM were noted between 2D (125 ± 42 g) and RT3DE values (bias: 1.2 g) with good correlation (r = 0.91, P < .001). However, the best correlation was noted between RT3DE and RT3DE-guided biplane LVM values (r = 0.95, P < .001, bias: −4.6 g). Intraobserver, interobserver variability, and test–retest variability of the RT3DE measurements were 9%, 12%, and 6%, respectively.

Conclusion

RT3DE imaging using the 3D surface detection algorithm allows accurate and reproducible measurements of LVM. RT3DE-guided biplane technique can be used as an accurate time-saving alternative in clinical practice.

Section snippets

RT3DE Assessment of LVM

Harmonic real-time transthoracic 3D imaging was performed using a commercial ultrasound imaging system (SONOS 7500 or iE33, Philips Medical Systems, Andover, MA) equipped with a matrix-array transducer (X4, 2.0/4.0 MHz or X3-1, 1.9/3.8 MHz, respectively) with the patient in the left lateral decubitus position. Gain and compression controls, as well as time gain compensation settings, were optimized to enhance image quality. Pyramidal volume datasets were acquired from the LV apical 4-chamber

Results

Acquisition of RT3DE datasets was feasible in all subjects. The time required for analysis, including endocardial and epicardial initialization, correction of boundaries, and computation of LVM, was 4.9 ± 1.5 minutes (range: 2.7-7.7 minutes).

Discussion

The results of protocol 1 demonstrated that semiautomated 3D analysis of the endocardial and epicardial surfaces from RT3DE full-volume datasets allows accurate assessment of LVM when compared with CMR reference values, with a small bias and relatively narrow limits of agreement. This is in agreement with previous studies, which used the same¹⁷ or another semiautomated technique¹⁸ to analyze RT3DE datasets and compared the results with CMR reference. Because this new algorithm tracks the entire

Conclusions

This 3D surface detection algorithm allows accurate and reproducible measurements of LVM within an acceptable analysis time. RT3DE-guided 2D LVM can be used as an accurate time-saving alternative in clinical practice. These techniques may become a new standard for the risk stratification of LVM in various cardiovascular diseases.

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: Disclosures: Masaaki Takeuchi: Equipment was loaned and software was donated. Roberto M. Lang: Software was donated. Ivan S. Salgo and Olivier Gerard are employees of Philips Medical Systems.

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Measurement of Left Ventricular Mass by Real-Time Three-Dimensional Echocardiography: Validation Against Magnetic Resonance and Comparison with Two-Dimensional and M-Mode Measurements

Background

Methods

Results

Conclusion

Section snippets

RT3DE Assessment of LVM

Results

Discussion

Conclusions

Am J Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

Am J Hypertens

Am J Cardiol

J Am Soc Echocardiogr

Left ventricular hypertrophy: pathogenesis, detection, and prognosis

Circulation