Abstract
Background: Left ventricular (LV) mass is an important prognostic factor in hypertrophic cardiomyopathy (HCM). LV mass can be easily accessed by M-mode or 2D echocardiography; however it includes assumption and might be incorrect in LV with asymmetricity. Real time three dimensional echocardiography (RT3DE) has been introduced as an accurate method to assess the LV mass and recently, RT3DE by single beat capture with online analysis program has been introduced. We validated LV mass using new RT3DE technique compared to cardiac magnetic resonance (CMR). Method: Thirty six HCM patients were consecutively enrolled and 3 patients were excluded due to poor RT3DE images. All the patients underwent CMR and RT3DE within the same day. LV mass was derived from the following methods; the ASE formula (M-mode mass), truncated ellipsoid method by 2D echocardiography (2D mass) and RT3DE (RT3DE mass). RT3DE image was acquired using the SC2000 System. The LV mass data were compared with the LV mass analyzed by CMR. Results: Mean frame rate of RT3DE was 13.1±2.3 frame/second. Pearson's interclass coefficient (ICC) showed close correlation of RT3DE mass and CMR mass (r=0.92 and p< 0.0001). However, M-mode mass and 2D mass had smaller ICC when compared with CMR (r=0.50, p=0.01 and r=0.78, p<0.001) Bland-Altman analysis showed reasonable limits of agreement with small positive bias (15.1). Bias was greater in M-mode LV mass and 2D LV mass (-39.1 and 21.2) Conclusions: LV mass measured by single-beat captured RT3DE is a feasible and accurate method in HCM patients. Because LV shape is asymmetrical in many subjects with HCM, LV mass derived from 2D or M-mode is much more inaccurate than symmetrical LVs. Correct assessment of LV mass using single-beat captured RT3DE will be useful in HCM patients in real clinical practice.
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