Quantitation of human left ventricular mass and volume by two-dimensional echocardiography: in vitro anatomic validation.

Abstract

The reliability of 2-dimensional echocardiographic (2-DE) quantitation of left ventricular (LV) section area, volume and myocardial mass was assessed in vitro in 13 postmortem human hearts (LV wt 115-454 g). The pathologic diagnoses included 2 normal, 5 coronary artery disease with infarction and/or aneurysm, 3 valvular heart disease, 2 cardiomyopathy and 1 left ventricular hypertrophy. Hearts were divided into 6-24 short-axis slices (no. = 123), imaged in a tank filled with mineral oil and the images planimetered. Calibrated photographs and actual LV weight served as reference standards. Estimates of section LV cavity volume and myocardial volume were derived by multiplying the appropriate area by section thickness. Section LV mass was obtained by multiplying the myocardial volume by myocardial density. Total LV cavity volume and myocardial mass were derived using Simpson''s rule and a short axis area-apical length method. In absolute terms 2-DE underestimated LV cavity area but accurately estimated LV myocardial area. Excellent correlations were obtained between 2-DE and photographic standards for section cavity area (r = 0.95) and volume (r = 0.90). Simpson''s rule (r = 0.97) and area-length (r = 0.82, r = 0.90, excluding 1 heart with a bizarrely shaped LV cavity secondary to extensive mural thrombus) estimates of total LV cavity volume correlated well with reference standards. Section LV myocardial area correlated well with photographic myocardial area (r = 0.89) and 2-DE and photographic estimates of section LV mass correlated well with actual LV wt (r = 0.92 and 0.96). Total LV mass obtained with Simpson''s rule or the area-length method was highly reliable (r = 0.93 and 0.92, respectively). 2-DE apparently can provide reliable estimates of LV volume and mass using the short-axis Simpson''s rule or area-length methods and appropriate regression corrections. The area-length method is simple enough to permit clinical application.