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Updated: Dec 4, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Left Ventricular Mass Assessment by 1- and 2-Dimensional Echocardiographic Methods in Hemodialysis Patients: Changes
Charlotte Burup Kristensen1, Frank Steensgaard-Hansen2, Katrine Aagaard Myhr1
1The Heart Center, Copenhagen University, Rigshospitalet, Copenhagen, Denmark.
Insights
Two-dimensional (2D) echocardiography methods provide a more stable measurement of left ventricular (LV) mass (LVM) in hemodialysis patients. Unlike 1D methods, 2D LVM calculations are unaffected by fluid shifts during dialysis.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Left ventricular (LV) mass (LVM) is a key predictor of cardiovascular events.
- Traditional 1-dimensional (1D) echocardiographic methods for LVM calculation are susceptible to measurement errors and variations in LV volume (LVV).
- Patients undergoing hemodialysis (HD) experience significant fluid fluctuations, potentially impacting LVM accuracy.
Purpose of the Study:
- To compare the accuracy of 1D and 2D echocardiographic methods for LVM assessment in hemodialysis patients.
- To evaluate the impact of fluid volume changes during HD on LVM measurements.
- To determine if 2D methods offer a more reliable LVM assessment in the presence of large fluid shifts.
Main Methods:
- Observational study involving 53 end-stage kidney disease patients undergoing one HD session.
- Transthoracic echocardiography performed pre- and post-HD.
- LVM calculated using 1D (Devereux, Penn, Teichholz) and 2D (truncated ellipsoid, area-length) methods.
Main Results:
- A 1-L increase in ultrafiltration volume correlated with a 1.1 mm decrease in LV internal diameter.
- Patients with greater fluid removal (>1.6 L) showed significant reductions in LVV and internal diameter post-HD.
- LVM calculated by 1D methods decreased with LVV changes, while 2D methods showed no significant change in LVM post-HD.
- No significant change in myocardial thickness or LVM was observed between pre- and post-HD using either method, indicating stable LVM.
Conclusions:
- Two-dimensional echocardiographic methods (truncated ellipsoid, area-length) are less affected by fluid and LVV fluctuations compared to 1D methods.
- The study recommends complementary LVM calculation using 2D methods, particularly in HD patients with significant fluid shifts.
- This approach can help avoid misinterpretations of increased LVM solely due to fluid fluctuations when using 1D methods.
Rationale & Objective:
Left ventricular (LV) mass (LVM) is a predictor of cardiovascular morbidity and mortality and commonly calculated using 1-dimensional (1D) echocardiographic methods. These methods are vulnerable to small measurement errors and LVM may wrongly change according to changes in LV volume (LVV). Less commonly used 2-dimensional (2D) methods can accommodate to the changes in LVV and may be a better alternative among patients receiving hemodialysis (HD) with large fluid fluctuations.
Study Design:
Observational study.
Setting & Participants:
Patients with end-stage kidney disease receiving HD.
Exposure:
One HD session.
Analytical Approach:
Transthoracic echocardiography was performed right before and after HD. LVM was calculated using 1D (Devereux, Penn, and Teichholz) and 2D methods (truncated ellipsoid and area-length).
Outcomes:
Significant differences in LVM after HD.
Results:
We compared dimensions, LVV and LVM, in 53 patients (mean age, 63 ± 15 years; 66% men). For each 1-L increase in ultrafiltration volume (UFV), LV internal diameter decreased 1.1 mm (95% CI, 0.5-1.7 mm; P = 0.001). Patients were divided into 2 groups by the median UFV of 1.6 L. Patients with UFV > 1.6 L had significant smaller LVV and LV internal diameter after HD. LVM calculated using 1D methods decreased according to changes in LVV. Conversely, LVM calculated using 2D methods was not significantly different after HD. No significant change in differences between diastolic - systolic myocardial thickness or LVM as assessed using 1D and 2D methods was observed before and after HD, indicating that LVM remained constant despite HD.
Limitations:
We did not use contrast enhancement, 3-dimensional methods, or cardiac magnetic resonance.
Conclusions:
LVM calculated using 2D methods, truncated ellipsoid and area-length, is less affected by fluctuations in fluid and LVV, in contrast to 1D methods. Complementary LVM calculation using 2D methods is encouraged, especially in patients with large fluid fluctuations in which increased LVM using a 1D method has been detected.
