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Echocardiography overestimates left ventricular mass: a comparative study with magnetic resonance imaging in patients
C G Missouris1, S M Forbat, D R Singer
1Department of Medicine, St George's Hospital Medical School, London, UK.
Insights
M-mode echocardiography and MRI yield significantly different left ventricular mass (LVM) measurements in hypertensive patients. These discrepancies, stemming from geometric assumptions in echocardiography, impact clinical assessments of left ventricular hypertrophy.
Area of Science:
- Cardiology
- Medical Imaging
- Hypertension Research
Background:
- Hypertension is a major risk factor for left ventricular hypertrophy (LVH).
- Accurate measurement of left ventricular mass (LVM) is crucial for assessing LVH severity and guiding treatment in hypertensive patients.
- Current methods for LVM estimation include M-mode echocardiography and magnetic resonance imaging (MRI).
Purpose of the Study:
- To compare the measurement of left ventricular mass (LVM) using M-mode echocardiography versus magnetic resonance imaging (MRI).
- To investigate the impact of geometric assumptions in M-mode echocardiography on LVM estimation in hypertensive individuals.
Main Methods:
- Prospective study involving 24 untreated hypertensive patients.
- LVM was measured using M-mode echocardiography with three standard formulas (ASE, Penn, Teichholz) and by MRI.
- Measurements were compared, accounting for cardiac cycle timing and specific MRI slice data.
Main Results:
- M-mode echocardiography yielded widely different LVM values (ASE: 319±21g, Penn: 273±19g, Teichholz: 191±11g).
- MRI provided a consistent LVM of 232±11g.
- Differences between MRI and echocardiography persisted even when applying MRI data to echocardiographic formulas, suggesting geometric assumption issues.
Conclusions:
- Significant discrepancies exist between LVM measurements obtained by echocardiography and MRI in hypertensive patients.
- The geometric assumptions inherent in one-dimensional M-mode echocardiography contribute substantially to these differences.
- These findings have critical implications for the clinical evaluation of LVH severity and treatment response in hypertension management.
Objective:
To compare measurement of left ventricular mass (LVM) by M-mode echocardiography and magnetic resonance imaging (MRI) in hypertensive subjects.
Design:
A prospective study.
Subjects:
Twenty-four untreated hypertensive patients [19 men and five women, aged 51 +/- 2 (mean +/- SEM) years, supine blood pressure 159/101 +/- 3/1 mmHg].
Setting:
The Blood Pressure Unit, St Georges Hospital Medical School and Magnetic Resonance Unit, Royal Brompton National Heart and Lung Hospital, London.
Main Outcome Measures:
LVM estimated both by M-mode echocardiography and by MRI.
Results:
Using three standard M-mode formulae, widely different values of LVM were obtained with echocardiography [American Society of Echocardiography (ASE) 319 +/- 21 g, Penn 273 +/- 19 g. Teichholz 191 +/- 11 g]. By MRI, the LVM was 232 +/- 11 g. The differences between MRI and echocardiography could not be explained in terms of the timing of measurements in the cardiac cycle. When single-slice MRI measurements at the appropriate level were applied to the ASE and Penn formulae, the LVM was again overestimated.
Conclusion:
Our study has shown major differences in LVM estimated using methods based on one-dimensional (echocardiography) compared with three-dimensional (MRI) data. These differences seem to be largely the result of the geometrical assumptions on which M-mode measurements are based. Our findings have important clinical implications for the assessment of the severity and response to treatment of left ventricular hypertrophy in hypertensive patients.