Calculation of Pediatric Left Ventricular Mass: Validation and Reference Values Using Real-Time Three-Dimensional Echocardiography

• Published in: Journal of the American Society of Echocardiography Vol. 28; no. 3; pp. 275 - 283
• Main Authors: Laser, Kai Thorsten, Houben, Britta Anna, Körperich, Hermann, Haas, Nikolaus Alexander, Kelter-Klöpping, Andrea, Barth, Peter, Burchert, Wolfgang, DallaPozza, Robert, Kececioglu, Deniz, Herberg, Ulrike
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2015
• Subjects: Adolescent; Cardiovascular; Child; Child, Preschool; Children; Computer Systems; Congenital heart disease; Echocardiography; Echocardiography, Three-Dimensional - standards; Female; Germany; Heart Defects, Congenital - diagnosis; Heart Ventricles - abnormalities; Heart Ventricles - diagnostic imaging; Heart Ventricles - pathology; Humans; Image Interpretation, Computer-Assisted - standards; Infant; Infant, Newborn; Left ventricular mass; Magnetic Resonance Imaging, Cine - standards; Male; Organ Size; Reference Values; Reproducibility of Results; Sensitivity and Specificity; 3D; BSA; LVM; Echocardiography; ICC; RT3DE; CMR; Left ventricular mass; Congenital heart disease; LV; Children; Intraclass correlation coefficient; Left ventricular; Real-time three-dimensional echocardiography; Three-dimensional; Cardiac magnetic resonance; Body surface area
• ISSN: 0894-7317; 1097-6795; 1097-6795
• DOI: 10.1016/j.echo.2014.11.008

Reference values for left ventricular mass (LVM) are important echocardiographic tools for the follow-up of pediatric patients with cardiac disease. Cardiac magnetic resonance (CMR) imaging is currently regarded as the gold standard. The aims of this study were to validate LVM calculated using real-time three-dimensional echocardiography (RT3DE) and to establish pediatric reference values. For validation, 40 subjects (20 patients) consecutively underwent CMR (3-T TX Achieva, 25 cardiac phases/slice) and RT3DE (iE33 or Vivid E9, four subvolumes) in a single-center approach. The quantification of CMR data by the disk summation method as standard (mean LVM, 84.2 ± 53 g; range, 17.7–231.7 g) was compared with RT3DE. In a multicenter prospective design, 434 healthy children were investigated using standard software (LV-Analysis version 3.1). In comparison with CMR, RT3DE provided a slight overestimation of LVM of only 2.5 ± 11.3% (r = 0.990, intraclass correlation coefficient = 0.995), and there was low intraobserver (mean, 0.9 ± 7.1%; scatter, 13.2% to −15.0%; r = 0.996; intraclass correlation coefficient = 0.998) and interobserver (mean, 1.5 ± 9.3%; scatter, 17.2% to −20.1%; r = 0.993; intraclass correlation coefficient = 0.996) variability. Feasibility of the multicenter approach was 76%, resulting in 332 healthy children (median age, 10.0 years; range, 0–18 years; group I range, 0–6 years; group II range, 7–18 years) with data sets providing adequate image quality. LVM was correlated with sex (group II), age (r = 0.901), height (r = 0.881), weight (r = 0.876), and body surface area (r = 0.898). Unisex percentiles for 0 to 6 years of age and separated according to gender from 7 to 18 years of age were established. Mean calculation time for RT3DE was <3 min. In children, LVM calculation presuming excellent real-time three-dimensional echocardiographic data sets is accurate, quick, and reproducible. The percentiles provided are based on a large sample size and may be useful for clinical practice.