Pediatric Cardiology

, Volume 40, Issue 2, pp 412–420 | Cite as

Left Ventricular Mass Quantification by Two-Dimensional Echocardiography in a Pediatric Population: Correlation with Cardiac Magnetic Resonance Imaging

  • Bradford J. Chu
  • Timothy Lee
  • John G. Gilbreth
  • James C. Nielsen
  • Achiau Ludomirsky
  • Justin T. Tretter
  • Puneet BhatlaEmail author
Original Article


Quantification of left ventricular (LV) mass by echocardiography has not been validated against the gold standard of cardiac magnetic resonance imaging (CMR) in the pediatric population. The purpose of this study was to compare LV mass by two-dimensional and conventional M-mode echocardiography versus CMR in children. Consecutive CMR studies were paired with echocardiograms and retrospectively analyzed in children age ≤ 16 years (3 days old to 16 years old). Studies performed > 3 months between modalities and single ventricle anatomy were excluded. Unindexed LV mass was calculated using M-mode, area-length (AL), and truncated ellipsoid (TE) methods via echocardiography, and compared to cine stack CMR images. There were 46 patients included in the study (both MRI and echocardiography). Good correlations were observed for LV mass measured by CMR and all echocardiographic methods: M-mode (R = 0.965), AL (R = 0.975), and TE (R = 0.975). There was a significant overestimation using TE echocardiography, by a mean of 10.5 g (95% confidence interval 5.7–15.2 g, p < 0.05). There was no significant over- or underestimation of LV mass observed by M-mode or AL echocardiographic measurements, with tight limits of agreement when compared to CMR (95% confidence interval − 5.2 to 4.4 g and − 1.5 to 6.7 g, respectively). Interobserver agreement was good for each of the echocardiographic measurements, but inferior with M-mode (ICC, 0.89) compared to two-dimensional methods (ICC, 0.97). Echocardiographic estimates of LV mass have good correlation with CMR in children. Performance comparison showed AL echocardiographic method provides the most accurate measurement of LV mass with the best reproducibility compared to other methods.


Left ventricular mass Left ventricular hypertrophy Echocardiography Cardiac magnetic resonance 



We are indebted to Dr. James C. Nielsen for his critical review and comments of our initial manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Lorell BH, Carabello BA (2000) Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 102:470–479CrossRefPubMedGoogle Scholar
  2. 2.
    Foppa M, Duncan BB, Rohde LE (2005) Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound 3:17CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458CrossRefPubMedGoogle Scholar
  4. 4.
    Yap SC, van Geuns RJ, Nemes A, Meijboom FJ, McGhie JS, Geleijnse ML, Simoons ML, Roos-Hesselink JW (2008) Rapid and accurate measurement of LV mass by biplane real-time 3D echocardiography in patients with concentric LV hypertrophy: comparison to CMR. Eur J Echocardiogr 9:255–260PubMedGoogle Scholar
  5. 5.
    Park SH, Shub C, Nobrega TP, Bailey KR, Seward JB (1996) Two-dimensional echocardiographic calculation of left ventricular mass as recommended by the American Society of Echocardiography: correlation with autopsy and M-mode echocardiography. J Am Soc Echocardiogr 9:119–128CrossRefPubMedGoogle Scholar
  6. 6.
    Armstrong AC, Gjesdal O, Almeida A, Nacif M, Wu C, Bluemke DA, Brumback L, Lima JA (2014) Left ventricular mass and hypertrophy by echocardiography and cardiac magnetic resonance: the multi-ethnic study of atherosclerosis. Echocardiography 31:12–20CrossRefPubMedGoogle Scholar
  7. 7.
    Hashimoto I, Ichida F, Tsubata S, Hamamichi Y, Uese K, Miyazaki A, Miyawaki T (1999) A novel method for indexing echocardiographic left ventricular mass in infants, children and adolescents: evaluation of obesity-induced left ventricular hypertrophy. Pediatr Int 41:126–131CrossRefPubMedGoogle Scholar
  8. 8.
    Cil E, Topaloglu H, Caglar M, Ozme S (1994) Left ventricular structure and function by echocardiography in congenital muscular dystrophy. Brain Dev 16:301–303CrossRefPubMedGoogle Scholar
  9. 9.
    Ribera MC, Ribera RB, Koifman RJ, Koifman S (2015) Echocardiography in sickle cell anaemia patients under 20 years of age: a descriptive study in the Brazilian Western Amazon. Cardiol Young 25:63–69CrossRefPubMedGoogle Scholar
  10. 10.
    Tretter JT, Chakravarti S, Bhatla P (2015) Use of echocardiographic subxiphoid five-sixth area length (bullet) method in evaluation of adequacy of borderline left ventricle in hypoplastic left heart complex. Ann Pediatr Cardiol 8:243–245CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Xu ZW, Shen J, Liu JF, Zhang HB, Zheng JH (2011) Judgement of the left ventricle retraining in the rapid two stage-switch operation. Zhonghua Wai Ke Za Zhi 49:158–161PubMedGoogle Scholar
  12. 12.
    Bostan C, Sinan UY, Canbolat P, Abaci O, Munipoglu SK, Kucukoglu S (2014) Factors predicting long-term mortality in patients with hypertrophic cardiomyopathy. Echocardiography 31:1056–1061CrossRefPubMedGoogle Scholar
  13. 13.
    Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618CrossRefPubMedGoogle Scholar
  14. 14.
    Margossian R, Schwartz ML, Prakash A, Wruck L, Colan SD, Atz AM, Bradley TJ, Fogel MA, Hurwitz LM, Marcus E, Powell AJ, Printz BF, Puchalski MD, Rychik J, Shirali G, Williams R, Yoo SJ, Geva T (2009) Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study). Am J Cardiol 104:419–428CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA (2012) LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 5:837–848CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gidding SS (2010) Controversies in the assessment of left ventricular mass. Hypertension 56:26–28CrossRefPubMedGoogle Scholar
  17. 17.
    Monoson PA, O’Rourke RA, Crwaford MH, White DH (1978) Measurements of left ventricular wall thickness and systolic thickening by M mode echocardiography: interobserver and intrapatient variability. J Clin Ultrasound 6:252–258CrossRefPubMedGoogle Scholar
  18. 18.
    Chirinos JA, Segers P, De Buyzere ML, Kronmal RA, Raja MW, De Bacquer D, Claessens T, Gillebert TC, St John-Sutton M, Rietzschel ER (2010) Left ventricular mass: allometric scaling, normative values, effect of obesity, and prognostic performance. Hypertension 56:91–98CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Friedberg MK, Su X, Tworetzky W, Soriano BD, Powell AJ, Marx GR (2010) Validation of 3D echocardiographic assessment of left ventricular volumes, mass, and ejection fraction in neonates and infants with congenital heart disease: a comparison study with cardiac MRI. Circ Cardiovasc Imaging 3:735–742CrossRefPubMedGoogle Scholar
  20. 20.
    Lu X, Xie M, Tomberlin D, Klas B, Nadvoretskiy V, Ayres N, Towbin J, Ge S (2008) How accurately, reproducibly, and efficiently can we measure left ventricular indices using M-mode, 2-dimensional, and 3-dimensional echocardiography in children? Am Heart J 155:946–953CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Bradford J. Chu
    • 1
  • Timothy Lee
    • 2
  • John G. Gilbreth
    • 1
  • James C. Nielsen
    • 1
  • Achiau Ludomirsky
    • 1
  • Justin T. Tretter
    • 3
  • Puneet Bhatla
    • 1
    Email author
  1. 1.Division of Pediatric Cardiology, Department of PediatricsNew York University School of MedicineNew YorkUSA
  2. 2.Department of Cardiothoracic SurgeryNew York University School of MedicineNew YorkUSA
  3. 3.Heart InstituteCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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