Comparison of Left Ventricular Mass Calculation Methods via Two-Dimensional Echocardiogram in Children, Adolescents, and Young Adults With Systemic Hypertension

https://doi.org/10.1016/j.amjcard.2019.04.023Get rights and content

Left ventricular (LV) mass is a major determining tool for myocardial injury in hypertensive patients. Issues with LV mass calculations exist given that there are multiple methods to assess mass, including from the parasternal long axis (PLA), parasternal short axis (PSA), and 2-dimensional (2D) volumetric methods. The aim of this study was to compare the agreement of LV mass calculations using the PLA, PSA, and 2D volumetric methods. This study retrospectively reviewed 200 consecutive, initial echocardiograms for the indication of hypertension. A single reader calculated the LV mass in each patient via the PLA, PSA, and 2D volumetric methods. Percent differences for each study were calculated. LV mass threshold cutoffs of 51 g/m2.7 (cardiac organ injury) and 38.6 g/m2.7 (elevated LV mass) were used to compare categorical differences between the different measurement methods. Paired comparisons demonstrated an absolute mean percent difference of 8.46% to 9.41% among the different methods. LV mass calculated by the 2D volumetric method was less compared with PLA and PSA methods (31.64 vs 33.90 vs 35.51 g/m2.7; p < 0.0001). Fewer patients were classified as having cardiac target organ injury or elevated LV mass via 2D volumetric calculation, compared with PLA and PSA methods (p = 0.02 and p = 0.03, respectively). In conclusion, there is a small but important difference in LV mass calculations for patients with hypertension. These results emphasize the need for consistency within echocardiography laboratories as surveillance studies are common in this patient population.

Section snippets

Methods

This study was approved by Cincinnati Children's Hospital Medical Center Institutional Review Board. We retrospectively reviewed 200 consecutive, initial echocardiograms for the indication of hypertension in patients 7 years of age and older, performed at Cincinnati Children's Hospital Medical Center. Cincinnati Children's Hospital Medical Center Echocardiography laboratory is an accredited Facility of the Intersocietal Accreditation Commission and performs approximately 18,000 total studies a

Results

A total of 200 consecutive echocardiograms were reviewed. There were 22 patients excluded; 1 patient was excluded for the previous diagnosis of dilated cardiomyopathy, 2 patients were excluded secondary to previously diagnosed congenital heart disease, and 19 patients were removed secondary to poor acoustic windows. Final analysis consisted of 178 patients (89%). Patient characteristics are provided on Table 1. Patient age ranged from 7 to 24 years of age. There was a moderate positive

Discussion

This study is the first to our knowledge to assess the difference in LV mass calculated with various 2D methods used in different pediatric echocardiography laboratories. Our results suggest an important variation within the different methods. Although overall paired comparison did not reveal a difference between PLA and PSA, 2D volumetric assessment demonstrated lower overall values, with fewer patients categorized with LV target organ damage and elevated LV mass.

Echocardiography is the

Disclosures

The authors declare that they have no conflicts of interest.

Grants: The authors report no financial disclosures, or funding sources.

View full text
© 2019 Elsevier Inc. All rights reserved.