© 2004 by European Society of Cardiology
Copyright © 2003, The European Society of Cardiology
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Stobhill Hospital, Department of Cardiology, Balornock Road, Glasgow G21 3UW, UK
amcgav{at}hotmail.com
* Tel.: +44-141-201-3000; fax: +44-141-558-5693.
Dear Sir,
It is encouraging that Dr Leslie and colleagues have found similar disparity between LV mass measurements using secondary harmonic imaging compared with fundamental imaging in their study group.
Our study was not designed to determine which modality provides the more accurate determination of LV mass, but served to demonstrate that calculated (not actual) LV mass differs when using measurements obtained by fundamental or secondary harmonic imaging. It would be attractive to believe that the better imaging provided by secondary harmonics would translate into more accurate LV mass estimation, but as discussed in our paper, the original formula for estimation of LV mass is a complex equation using a "best fit" mathematical model based on comparison to necropsy findings.1,2 This formula is based on measurements of wall thickness and cavity size determined by fundamental imaging and given that these individual measurements are altered when assessed by secondary harmonic imaging, this equation, by its very nature of being a "best fit", can no longer be mathematically valid. It is therefore interesting that Dr Leslie et al. found that LV mass by secondary harmonics gave similar results to MR estimation, but I am at a loss to explain this given the systematic error inherent when one inputs measurements obtained by secondary harmonic imaging into a mathematical formula based on values obtained by fundamental echo imaging.
However, this is probably a moot point, as is the argument of whether fundamental or secondary harmonic imaging provides the more accurate measurement of true LV mass, given that normal ranges and partition values for LVH are from the presecondary harmonic era. Both Dr Leslie's and our study reinforce that decisions regarding the management of patients based on raised LV mass calculated by secondary harmonic imaging should be made with caution and that new reference ranges using this modality are required. Validation of new reference range, partition values, or indeed a new formula, could be achieved with comparison to MR data.
Yours sincerely,
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- Devereux R., Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation (1977) 55:613–618.
[Abstract/Free Full Text] - Devereux R., Alonso D., Lutas E., Gottlieb G., Sachas I. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol (1986) 57:450–458.[CrossRef][Web of Science][Medline]
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