Discrepancies between echocardiographic measurements of left ventricular mass in a healthy adult population

1999 ◽  
Vol 97 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Jenny A. DEAGUE ◽  
Catherine M. WILSON ◽  
Leeanne E. GRIGG ◽  
Stephen B. HARRAP
Keyword(s):  
Healthy Adult ◽  
Adult Population ◽  
Statistical Test ◽  
Left Ventricular ◽  
Altman Analysis ◽  
Cardiovascular Morbidity And Mortality ◽  
Lv Mass ◽  
Heart Size ◽  
The Difference ◽  
American Society

Increased left ventricular (LV) mass is associated with increased cardiovascular morbidity and mortality. LV mass is commonly estimated from echocardiography according to the Penn or ASE (American Society of Echocardiography) conventions. No formal statistical test of agreement between these methods has been published. Therefore we compared M-mode echocardiographic LV mass estimates by the Penn and ASE methods in a normal adult population. M-mode echocardiographic tracings were obtained in 169 healthy volunteers and used to calculate LV mass using the Penn and ASE methods. Median values of the estimates were similar [Penn, 126 g (interquartile range 96–170 g); ASE, 129 g (105–164 g); P = 0.08] and were highly intercorrelated (r = 0.98, P < 0.0001). However, the Bland–Altman analysis of agreement revealed significant inconsistencies between Penn and ASE LV mass values. The difference between Penn and ASE values was correlated significantly with heart size (P < 0.0001), such that, for small hearts, the Penn LV mass was lower than the ASE LV mass; in contrast, for large hearts, Penn estimates were greater than ASE values. In the upper 5% of the LV mass distribution, the median value for the Penn LV mass index was 132.4 g/m2, compared with 116.5 g/m2 for ASE values (2P = 0.017). Thus the two most common methods of echocardiographic estimation of LV mass differ significantly at the upper and lower ends of the heart size distribution. These results have important implications for both cardiac research and clinical evaluation.

Abstract 3435: Left Ventricular Hypertrophy is Resistant to Inhibition of Expression of the R403Q Alpha-Myosin Heavy Chain Cardiac Hypertrophy-Inducing Mutant Protein

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Leah Cannon ◽  
Tadeusz Marciniec ◽  
Bryony Mearns ◽  
Robert M Graham ◽  
Diane Fatkin
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Interstitial Fibrosis ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Familial Hypertrophic Cardiomyopathy ◽  
Lv Function ◽  
Dependent Manner ◽  
Cardiovascular Morbidity And Mortality ◽  
Lv Mass

Left ventricular hypertrophy (LVH) develops as a compensatory response to myocardial dysfunction due to diverse causes, but is nonetheless a major risk factor for premature cardiovascular morbidity and mortality. It is thus unclear if regressing LVH is beneficial or may worsen patient outcome. To evaluate the effects of LVH regression, we developed a transgenic mouse model in which the expression of a familial hypertrophic cardiomyopathy (FHC)-inducing mutation (R403Q alpha-MHC) can be regulated in a temporal and dose-dependent manner. In this model, transgene expression can be shut off by feeding with a tetracycline analogue (doxycycline). Serial echocardiography and histology studies were performed in a cohort of mice expressing the FHC mutant (“gene-on”) and in wildtype (WT) littermates. A second cohort of WT and 403/+ mice was randomised to placebo or doxycycline (“gene off”) from 6 (Dox6) or 20 weeks (Dox20) and evaluated at 40 weeks of age. Compared to WT littermates, “gene on” 403/+ mice showed increased LV mass, LV end-diastolic diameter (LVDD) and left atrial diameter (LAD), and reduced fractional shortening (LVFS), with changes evident from 12 weeks of age. LV sections from 403/+ mice showed typical features of FHC: myofibre disarray and interstitial fibrosis. LV mass, LV function and myocardial histology were unchanged in both male and female placebo- vs Dox6 or Dox20 mice at 40 weeks (Table 1 ). Thus, consistent with the major LV thickening in FHC humans occurring in adolescence, overexpression of R403Q for only 6 weeks is sufficient to trigger the complete LVH phenotypic response. Moreover, switching off the genetic trigger for LVH in 403/+ mice at 6 weeks (prior to overt disease manifestation) or 20 weeks (established disease) does not induce regression of LVH or exacerbate contractile dysfunction. Interventions to induce LVH regression may, therefore, need to be directed at downstream factors in hypertrophic pathways. Table 1. Echo data for male WT and 403/+ mice aged 40 weeks

Abstract 3269: Association of Aortic Regurgitation with Cardiovascular Morbidity and Mortality in Hypertensive Patients with Left Ventricle Hypertrophy: The LIFE study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zhibin Li ◽  
Kristian Wachtell ◽  
Sverre E. Kjeldsen ◽  
Stevo Julius ◽  
Michael H. Olsen ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Cox Regression ◽  
Left Ventricular ◽  
Morbidity And Mortality ◽  
Hypertensive Patients ◽  
Life Study ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Lv Mass ◽  
Ventricle Hypertrophy

Background : Whether aortic regurgitation (AI) is associated with higher cardiovascular (CV) morbidity and mortality in hypertension with electrocardiographic (ECG) left ventricular hypertrophy (LVH) is unknown. Methods : Hypertensive patients with ECG-LVH were randomized to losartan- or atenolol-based treatment and followed for 4.8 years in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. In the LIFE echo substudy, echocardiograms were used to detect AI. Baseline clinical, echocardiographic variables and cardiovascular endpoints data were used in current analyses. Results: The presence of AI was detected in 132 participants (68 women; 68.4 ± 7.3 years). AI was associated with older age (p < 0.001) but not gender. After adjustment for age, AI was associated with significantly increased LV mass indexed by body surface area (BSA) and height 2.7 (both p < 0.005), echocardiographic eccentric LVH (p < 0.05) but not concentric left ventricular (LV) geometry (p < 0.05). After adjusting for significant confounders including history of CV disease, Framingham risk score, randomized antihypertensive therapy, LV eccentric geometry, LV mass indexed by BSA and height 2.7 , multivariate Cox regression analyses showed that AI was independently associated with 2.83-fold more CV death (95% confidence interval [CI] 1.12 to 7.13), 2.24-fold more all-cause mortality (95% CI 1.17 to 4.28) (both p < 0.05). Conclusion : In hypertensive patients with ECG-LVH, AI independently identifies patients at increased risk of CV and all-course mortality.

scholarly journals Cardiovascular morbidity and mortality in patients treated with hemodialysis: Epidemiological analysis

2008 ◽  
Vol 65 (12) ◽  
pp. 893-900 ◽  
Author(s):  
Dejan Petrovic ◽  
Biljana Stojimirovic
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Mortality Rate ◽  
Cardiovascular Mortality ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Cardiovascular Morbidity And Mortality ◽  
Lv Mass

Background/Aim. Cardiovascular diseases are the leading cause of death in patients treated with hemodialysis (HD). The annual cardiovascular mortality rate in these patients is 9%. Left ventricular (LV) hypertrophy, ischemic heart disease and heart failure are the most prevalent cardiovascular causes of death. The aim of this study was to assess the prevalence of traditional and nontraditional risk factors for cardiovascular complications, to assess the prevalence of cardiovascular complications and overall and cardiovascular mortality rate in patients on HD. Methods. We investigated a total of 115 patients undergoing HD for at least 6 months. First, a cross-sectional study was performed, followed by a two-year follow-up study. Beside standard biochemical parameters, we also determined cardiac troponins and echocardiographic parameters of LV morphology and function (LV mass index, LV fractional shortening, LV ejection fraction). The results were analyzed using the Student's t test and Mann-Whitney U test. Results. The patients with adverse outcome had significantly lower serum albumin (p < 0.01) and higher serum homocystein, troponin I and T, and LV mass index (p < 0.01). Hyperhomocysteinemia, anemia, hypertriglyceridemia and uncontrolled hypertension had the highest prevalence (86.09%, 76.52%, 43.48% and 36.52%, respectively) among all investigated cardiovascular risk factors. Hypertrophy of the LV was presented in 71.31% of the patients and congestive heart failure in 8.70%. Heart valve calcification was found in 48.70% of the patients, pericardial effusion in 25.22% and disrrhythmia in 20.87% of the investigated patients. The average annual overall mortality rate was 13.74%, while average cardiovascular mortality rate was 8.51%. Conclusion. Patients on HD have high risk for cardiovascular morbidity and mortality.

Abstract 2292: Torsional Deformation Delay: a Novel Echocardiographic Index of Left Ventricular Peak Rotation Sequence Between Basal and Apical Level.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lukasz Chrzanowski ◽  
Barbara Uznanska ◽  
Michal Plewka ◽  
Piotr Lipiec ◽  
Jaroslaw Drozdz ◽  
...  
Keyword(s):  
Systolic Function ◽  
Temporal Distribution ◽  
Left Ventricular ◽  
Torsional Deformation ◽  
Lv Mass ◽  
Echocardiographic Parameters ◽  
The Difference ◽  
Lv Systolic Function ◽  
Rotation Sequence

Purpose: left ventricular (LV) torsion (TOR) results from oppositely directed rotation (ROT) at the basal (BAS) and apical (AP) level. Speckle Tracking Echocardiography (STE) allows TOR assessment, but little is known of LV ROT temporal distribution. The aim was to evaluate the sequence of BAS and AP level ROT and to identify associated echocardiographic parameters. Methods: 48 patients (PTS) were studied (mean age 54±13 years, 23 men). LV systolic function was normal in 23 PTS (LVEF 60% or more), and various degrees of dysfunction were present in 25 PTS (mean LVEF 40±10%). Digital short axis loops at BAS and AP level were analyzed using STE algorithm to measure ROT in degrees (°). After adjustment for heart rate, Torsional Deformation Delay (TDD) was calculated as the difference between the time from the onset of QRS complex to the peak average systolic ROT at BAS and AP level (figure ). Results: mean TOR, BAS ROT and AP ROT was 14.3±7.3°, −6.8±4.7° and 7.5±6.1° respectively. Mean TDD was 19±107 ms (range from −285 to 248 ms); negative TDD indicated shorter time to BAS peak ROT. No difference of mean TDD was found between PTS with normal and decreased LVEF. TDD outside the range of −28 ms to 28 ms, derived by ROC analysis, was shown to have 96% specificity in detecting PTS with LVEF <60%. It was also associated with higher LV mass index as compared to TDD ranging from −28 to 28 ms (130 g/m2 vs 100 g/m2, p=0.025). Conclusions: a novel TDD index allows evaluation of LV ROT temporal distribution between BAS and AP level. TDD values outside the range of −28 ms to 28 ms are associated with decreased LVEF and presence of LV hypertrophy. Further studies are required to assess the role of TDD in cardiac imaging.

Sino-nasal assessment questionnaire: a specific outcome measure for rhinosinusitis, but what is the range in the asymptomatic population?

2006 ◽  
Vol 121 (7) ◽  
pp. 650-652
Author(s):  
F Younis ◽  
S Duvvi ◽  
T Walker ◽  
B Nirmal Kumar
Keyword(s):  
Outcome Measure ◽  
Healthy Adult ◽  
Normal Population ◽  
Adult Population ◽  
Sinus Surgery ◽  
Asymptomatic Group ◽  
Symptom Scores ◽  
Specific Outcome ◽  
The Difference ◽  
Assessment Questionnaire

The sino-nasal assessment questionnaire is a system used for scoring the symptoms of chronic rhinosinusitis. However, the range of scores for this questionnaire in the healthy adult population is unknown. We aimed to establish this by recruiting 100 healthy volunteers and comparing their sino-nasal assessment questionnaire scores with those of 100 individuals who had undergone sinus surgery for rhinosinusitis. The difference in mean scores in the symptomatic group (44.62) and the asymptomatic group (8.46) was statistically significant. However, there was substantial overlap between the scores of the two groups. Factors such as age, gender and smoking did not have a statistically significant impact on the eventual score in the asymptomatic group. We believe that symptom scores can only be used effectively when the range in the asymptomatic population is known. This is so that disease severity can be gauged in the context of the normal population and post-operative improvements can be forecast.

Abstract 17984: Validating the Gold-standard: Steady-State Free Precession Sequence for Assessment of Left Ventricular and Right Ventricular Mass

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Carlos G Santos-Gallego ◽  
Ida U Njerve ◽  
Kiyotake Ishikawa ◽  
Jaime Aguero ◽  
Torsten Vahl ◽  
...  
Keyword(s):  
Steady State ◽  
Right Ventricular ◽  
Gold Standard ◽  
Steady State Free Precession ◽  
Left Ventricular ◽  
Free Precession ◽  
Post Surgery ◽  
Cardiovascular Morbidity And Mortality ◽  
Lv Mass

Background: Left ventricular (LV) mass (LVM) predicts cardiovascular morbidity and mortality, thus accurate quantification of LVM is essential. Cardiac magnetic resonance (CMR) is considered the gold-standard for LVM and right ventricular (RV) mass (RVM) quantification. The steady-state free precession (SSFP) is the most widely used sequence nowadays; however, SSFP-derived LVM/RVM has only been validated in normal animals, while CMR is usually performed under pathological conditions. Therefore, our objective was to validate in vivo SSFP-derived LVM/RVM with the gold-standard autopsy weights of experimental animals with myocardial infarction (MI), LV remodeling, and pulmonary hypertension (PH). Methods: MI was induced in 11 pigs by balloon occlusion of the proximal LAD for 60 min, and MRIs were obtained 2 months post-MI. PH was induced in 11 pigs by surgical ligation of three pulmonary veins and animals underwent CMR 4 months post-surgery. Animals were euthanized immediately after CMR. Each ventricle was separately weighted using a high-fidelity scale. MRI studies were performed with a 3.0 Tesla magnet. Results: In the MI model, infarct size (IS) was 29±6% of LV, LVEF 34±8%, RVEF 62±149%, mean pulmonary artery pressure (mPAP) 16±4mmHg, and pulmonary vascular resistance (PVR) 2.3±1.1 Wood units. In the PH model, IS was 0%, LVEF 64±5%, RVEF 55±10%, mPAP 36±16mmHg and PVR was 7.2±5.5 Wood units. All animals provided images of diagnostic quality. Excellent correlations were obtained between SSFP-calculated LV mass (86.6±12.9g) and autopsy-measured LV mass (91.1±15.2g, r=0.97, p<0.001). For LV, the correlation was not different in both groups of animals (r=0.98, p=0.01 for post-MI animals; r=0.96, p=0.01 for PH animals). There was also a strong correlation between RV mass obtained from CMR (37.9±14.1g) and from autopsy (41.6±13.1g r=0.9, p=0.01). For RV, the correlation was higher in PH animals (r=0.92, p<0.001) than in post-MI pigs (r=0.8, p=0.01). Conclusions: In vivo SSFP-CMR sequences determine LVM and RVM accurately and reliably compared with autopsy. Therefore, our study provides further validation for the clinical use of SSFP sequence derived LVM and RVM.

P2729NT-proBNP and high-sensitivity cardiac troponin T to diagnose cardiac amyloidosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Castiglione ◽  
A Aimo ◽  
A Barison ◽  
D Genovesi ◽  
C Prontera ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Cardiac Amyloidosis ◽  
Troponin T ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Clinical Suspicion ◽  
Al Amyloidosis ◽  
Cardiac Troponin T ◽  
Lv Mass ◽  
The Difference

Abstract Background Cardiac amyloidosis (CA) is characterized by the accumulation of misfolded proteins into amyloid fibrils, leading to cardiomyocyte toxicity, extracellular volume expansion and ventricular pseudohypertrophy. As a consequence of such processes, natriuretic peptides and cardiac troponins are chronically elevated in CA and hold significant prognostic value. The diagnostic yield of these biomarkers for CA has never been explored so far. Methods Plasma levels of N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured in 230 patients referred to a tertiary centre with the clinical suspicion of cardiac amyloidosis. The final diagnosis was established according to current protocols, which include clinical, electrocardiographic, biohumoral, instrumental (echocardiography, cardiac magnetic resonance, diphosphonate scintigraphy), and biopsy examinations. Results Patients were aged 79 (interquartile interval 73–83) years and were predominantly males (n=147, 64%). Mean left ventricular (LV) ejection fraction was 55% (48–62%), and mean LV mass indexed was 150 (120–178) g/m2. CA was confirmed in 86 patients (37%), who had either light chain (AL) amyloidosis (n=25, 29%) or transthyretin (ATTR) amyloidosis (n=61, 71%). Alternative diagnoses were hypertensive cardiopathy (n=69, 48%), valvular disease (n=27, 19%), hypertrophic cardiomyopathy (n=18, 13%), or left ventricular hypertrophy with unknown or multifactorial mechanisms. Patients with CA showed higher NT-proBNP (5507 ng/L [2348–10326] vs. 1332 [392–3752], p<0.001) and hs-cTnT (65 ng/L [48–114] vs. 35 [21–52], p<0.001) than those without CA. The area under the curve (AUC) values for NT-proBNP and hs-cTnT were 0.712 and 0.775 respectively (p=0.062 for the difference). The combination of the two biomarkers improved discrimination over NT-proBNP alone (p=0.011), but not over hs-cTnT (p=0.470) (Figure). A NT-proBNP level <600 ng/L or a hs-cTnT level <17 ng/L were optimal for ruling out amyloidosis, with a negative predictive value of 95% in both cases. Patients with AL amyloidosis had higher NT-proBNP and hs-cTnT than those with ATTR (10809 ng/L [6292–17483] vs. 3084 [1841–7624], p=0.014; 130 ng/L [64–211] vs. 61 [48–95], p=0.006). The difference was even more prominent when biomarker levels were normalized for LV mass (NT-proBNP/LV mass, 33.9 ng/L/g [20.4–53.8] vs. 10.0 [5.8–23.5], p=0.002; hs-cTnT/LV mass, 0.48 ng/L/g [0.25–0.71] vs. 0.19 [0.14–0.26], p=0.001). NT-proBNP and hs-cTnT could effectively discriminate patients with AL amyloidosis among subjects with clinical suspicion of CA (AUC values of 0.787 and 0.805 respectively) (Figure). Figure 1 Conclusions Plasma NT-proBNP and hs-cTnT have diagnostic value in patients with suspected CA. In the subgroup with CA, both biomarkers are higher in patients with AL amyloidosis even when normalizing for LV mass, possibly because of a greater cardiotoxic effect of light-chain fibrils.

Discrepancies between echocardiographic measurements of left ventricular mass in a healthy adult population

1999 ◽  
Vol 97 (3) ◽  
pp. 377 ◽  
Author(s):  
Jenny A. DEAGUE ◽  
Catherine M. WILSON ◽  
Leeanne E. GRIGG ◽  
Stephen B. HARRAP
Keyword(s):  
Left Ventricular Mass ◽  
Healthy Adult ◽  
Adult Population ◽  
Left Ventricular ◽  
Ventricular Mass

scholarly journals Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients

2021 ◽  
Vol 10 (6) ◽  
pp. 1279
Author(s):  
Andrea Barbieri ◽  
Francesca Bursi ◽  
Giovanni Camaioni ◽  
Anna Maisano ◽  
Jacopo Francesco Imberti ◽  
...  
Keyword(s):  
Machine Learning ◽  
Linear Method ◽  
Left Ventricular ◽  
Human Interaction ◽  
3D Analysis ◽  
3 Dimensional ◽  
Automated Algorithm ◽  
Linear Dimensions ◽  
Lv Mass ◽  
The Difference

A recently developed algorithm for 3D analysis based on machine learning (ML) principles detects left ventricular (LV) mass without any human interaction. We retrospectively studied the correlation between 2D-derived linear dimensions using the ASE/EACVI-recommended formula and 3D automated, ML-based methods (Philips HeartModel) regarding LV mass quantification in unselected patients undergoing echocardiography. We included 130 patients (mean age 60 ± 18 years; 45% women). There was only discrete agreement between 2D and 3D measurements of LV mass (r = 0.662, r2 = 0.348, p < 0.001). The automated algorithm yielded an overestimation of LV mass compared to the linear method (Bland–Altman positive bias of 13.1 g with 95% limits of the agreement at 4.5 to 21.6 g, p = 0.003, ICC 0.78 (95%CI 0.68−8.4). There was a significant proportional bias (Beta −0.22, t = −2.9) p = 0.005, the variance of the difference varied across the range of LV mass. When the published cut-offs for LV mass abnormality were used, the observed proportion of overall agreement was 77% (kappa = 0.32, p < 0.001). In consecutive patients undergoing echocardiography for any indications, LV mass assessment by 3D analysis using a novel ML-based algorithm showed systematic differences and wide limits of agreements compared with quantification by ASE/EACVI- recommended formula when the current cut-offs and partition values were applied.

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