Canine left ventricular mass estimation by two-dimensional echocardiography

This study was designed to develop a two-dimensional echocardiographic method of measuring the mass of the left ventricle. The general formula for an ellipse was used to derive an algorithm that described the shell volume of concentric truncated ellipsoids. In 10 canine left ventricular two-dimensional echocardiograms, this algorithm accurately predicted postmortem left ventricular mass (r = .98, SEE +/- 6 g) and was independent of cardiac cycle phase (systole vs diastole, r = .92).     

Reproducibility of left ventricular mass measurements by two-dimensional and M-mode echocardiography

Both two-dimensional and M-mode echocardiography provide accurate estimates of left ventricular mass. However, their reproducibility in serial studies has not been compared, although this issue is critical to evaluation of regression of hypertrophy. To determine which technique provides more reproducible estimates of left ventricular mass, three serial studies were performed prospectively in each of eight normal adults over 5 months. Both two-dimensional and M-mode echocardiograms were obtained at each of these 24 studies. Measurements were performed by two independent observers who did not know patient identity. For the two-dimensional method, left ventricular mass was determined with use of a computer light-pen system and the truncated ellipsoid formula. For the M-mode method, mass was calculated from Penn convention measurements with use of the cube formula. At study 1 the group mean left ventricular mass by two-dimensional echocardiography (115 +/- 20 g) did not differ from that by M-mode study (127 +/- 37 g, p = NS). However, serial estimates of left ventricular mass were more reproducible by two-dimensional echocardiography. The mean difference among the three serial two-dimensional studies in each individual was 4.8 +/- 4 g (4.2 +/- 3%) by the two-dimensional method, but was 18.5 +/- 13 g (14.9 +/- 10%) by the M-mode method (p = 0.01). Interobserver results for left ventricular mass by two-dimensional echocardiography correlated closely (r = 0.95, n = 24, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnosis of left ventricular thrombi by two-dimensional echocardiography.

Sixteen patients had two-dimensional echocardiographic diagnosis of the presence or absence of left ventricular thrombi and anatomical, radiological, or clinical confirmation of the diagnosis. Eleven patients had positive diagnoses, which were confirmed in 10 and possibly incorrect in one. Five other records were reviewed because the patients had undergone aneurysmectomy after two-dimensional echocardiograms: three were true negative and two were false negative studies.     

Non-invasive left ventricular volume determination by two-dimensional echocardiography.

Twenty patients undergoing routine left ventricular single-plane angiography have been investigated by an ultrasonic triggered B-scan technique to provide a two-dimensional cross-sectional image of the left ventricle in end-systole end-diastole. An area-length method has been used to establish the correlation between the angiographic and the echocardiographic assessments of left ventricular chamber volume (r equals 0.88) and ejection fraction (r equals 0.81). Differences between the two techniques are discussed, and it is concluded that in approximately 80 per cent of patients triggered B-scanning may provide a safe, non-invasive, and convenient technique for the determination of volumes and certain functional parameters, especially in patients with dilated hearts and irregular left ventricular shape, where M-scanning is known to be less reliable.     

Papillary fibroelastoma presenting as left ventricular mass

A 38-year-old woman presented with chest pain. Two-dimensional echocardiography revealed a mobile mass in the left ventricle, attached to the posterior papillary muscle of the mitral valve without valvular involvement. The tumor was resected. Histopathology confirmed the tumor as papillary fibroelastoma. Our case highlights an atypical presentation of papillary fibroelastoma.     

Intravascular volume dependency of left ventricular mass calculation by two-dimensional guided M-mode echocardiography

BACKGROUND: Increased left ventricular mass (LVM) is an independent risk factor for cardiovascular morbidity and mortality, and may be used for risk stratification. Two-dimensional echocardiography, the most commonly used technique for estimation of LVM, uses the third power of the left ventricular internal diameter (LVID) for the calculation. OBJECTIVES: To determine whether a decrease in intravascular volume after dialysis may cause inaccurate estimation of LVM by echocardiography. METHODS: Thirty-eight patients undergoing hemodialysis due to chronic renal failure constituted the study group (14 women [37%] and 24 men [63%], mean age +/- SD 38.7+/-10.9 years). LVID, and interventricular and posterior wall thicknesses were measured by two-dimensionally guided M-mode echocardiography. Stroke volume and cardiac output were calculated using left ventricular outflow tract diameter and the pulsed-wave Doppler time-velocity integral obtained from left ventricular outflow tract. LVM was calculated by using Devereux's formula, and was indexed for body surface area and height. All echocardiographic parameters were measured or calculated before and after dialysis (on the same day), and then compared. RESULTS: There were no significant changes in wall thickness; however, LVID, LVM, the LVM/body surface index and the LVM/height index significantly decreased after dialysis (P<0.001 for each parameter). There was a significant correlation between the change in LVID and the change in LVM (P<0.001, r=0.59). Stroke volume and cardiac output also decreased significantly after hemodialysis (P<0.001 for each parameter). CONCLUSIONS: Intravascular volume-dependent change in LVID causes inaccurate estimation of LVM, so volume status should be kept in mind, especially in serial assessment of LVM.     

Diagnosis of left ventricular thrombi by two-dimensional echocardiography

Sixteen patients had two-dimensional echocardiographic diagnosis of the presence or absence of left ventricular thrombi and anatomical, radiological, or clinical confirmation of the diagnosis. Eleven patients had positive diagnoses, which were confirmed in 10 and possibly incorrect in one. Five other records were reviewed because the patients had undergone aneurysmectomy after two-dimensional echocardiograms: three were true negative and two were false negative studies.     

Coronary artery to left ventricular fistula demonstrated by transthoracic echocardiography

Coronary artery fistulas are rare coronary anomalies which generallyrequire coronary angiography for definitive diagnosis. Improvementsin ultrasound technology has enabled direct, transthoracic visualizationof long portions of coronary arteries. We report a patient witha symptomatic coronary to left ventricular fistula, which wasdiagnosed with transthoracic echocardiography.     

Quantitative study of left ventricular function by two-dimensional echocardiography

The results of two dimensional echocardiography and cineventriculography in the calculation of left ventricular volumes and ejection fractions were compared. The study was performed experimentally in dogs and also in 12 patients with ischaemic heart disease. 25 measurements were performed in the animal: 19 basal and 6 measurements one hour after occlusion of the LAD. Reconstruction by Simpson's method showed good correlations with angiography (p less than 0,001) for enddiastolic volume (r = 0,94), end systolic volume (r = 0,97) and ejection fraction (r = 0,89). A preliminary clinical study was performed in 12 patients. All had significant stenosis of at least one main coronary artery and 10 had segmental abnormalities of left ventricular wall motion. Left ventricular volumes were calculated from the simplified 5/6 AL formula which only requires one long axis view and one short axis view at the level of the papillary muscles. The comparison between echocardiography and angiography showed a better correlation for end systolic volume (r = 0,91) than for end diastolic volume (r = 0,73). Echo underestimated end diastolic volume by 14% and end systolic volume by 13%. The correlation obtained for ejection fraction was excellent (r = 0,97) with no underestimation of this parameter by echocardiography. In conclusion, left ventricular volumes and ejection fractions may be calculated by two dimensional echocardiography. The technique allows a sequential quantitative study from beat to beat and in real time of cardiac function. It is a simple non-invasive method of following the evolution of cardiac disease and of assessing the effects of therapy on left ventricular function.     

Assessment of left ventricular aneurysm resectability by two-dimensional echocardiography

Mortality of surgical resection of a left ventricular (LV) aneurysm is largely determined by size and function of nonaneurysmal or residual myocardium. A residual myocardial index was determined using 2-dimensional echocardiography (2-D echo) in 56 consecutive patients scheduled for LV aneurysmectomy, and these results were correlated with surgical outcome. The index was calculated using 3 apical cross sections: the 2- and 4-chamber views and the long-axis view. These views were recorded at mutual angles of 60 degrees. In each view the end-diastolic length of normally moving endocardium of the 2 opposite walls was expressed as a fraction of the end-diastolic LV long axis. The index was assessed by averaging the 6 ratios obtained. In 41 survivors the index ranged from 40 to 71% (mean +/- standard deviation 53 +/- 7.8) and in 15 nonsurvivors from 29 to 67% (mean 38 +/- 8.5, p less than 0.01). With 1 exception, this echocardiographic index sharply separated survivors from nonsurvivors. The lower limit to survive aneurysmectomy was 40%.     

Detection of left ventricular false tendons by two-dimensional echocardiography

In a prospective series of 300 consecutive patients referred for a two-dimensional echocardiogram, the presence of left ventricular false tendons was searched. The diagnosis of a false tendon was made when a clear linear echo was continuously observed within the left ventricular cavity from the septum to the free wall or to a papillary muscle. Using this criterion, a false tendon was detected in 9 of the 300 patients (incidence of 3%), frequently from an apical position. The precise sites of attachment of the false tendons were observed by slight rotation and/or angulation of the transducer from the classic views: the septum and the lateral papillary muscle were the most frequent sites of attachment. Associated congenital heart disease was present in only 1 patient. Most patients had moderate symptoms and a soft musical systolic murmur. Three patients had premature ventricular contractions disappearing with exercise. The possible relations of LV false tendons with a musical murmur, arrhythmia or abnormal LV geometry are discussed.