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European Journal of Echocardiography 2004 5(4):243; doi:10.1016/j.euje.2004.03.004
© 2004 by European Society of Cardiology
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Copyright © 2004, The European Society of Cardiology

Overestimation of left ventricular mass

Nicolas Mansencal, MD* and Olivier Dubourg, MD, FESC

Assistance Publique—Hôpitaux de Paris, Hôpital Universitaire Ambroise Paré, Service de Cardiologie, 9, avenue Charles de Gaulle, 92100 Boulogne, France

nicolas.mansencal{at}apr.ap-hop-paris.fr

* Corresponding author. Tel.: +33-149-095620; fax: +33-149-095344.

Overestimation of left ventricular mass: yes, but with which imaging? We read with interest the article by Kuhl et al.,1 which demonstrated that left ventricular mass using conventional M-mode echocardiography is overestimated, as compared to left ventricular mass using 3D echo. The authors have to be congratulated to have previously validated this 3D technique against MRI. These results are stimulating and encourage the validation of the recent real-time transthoracic 3D echocardiography. However, this study raises a methodological issue that may alter the soundness of the conclusion. The concern relates to the use of transthoracic echocardiographic imaging. The authors did not explain which echocardiographic imaging has been used: fundamental or second harmonic imaging? All published equations to calculate LV mass have been validated using fundamental M-mode imaging. Furthermore, in a recent prospective study and confirmed by two others, second harmonic imaging led to an overestimation of left ventricular wall thickness and left ventricular mass compared with fundamental imaging.2–4 Therefore, the conclusion of the present study should be interpreted cautiously if second harmonic imaging was used.


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  1. Kuhl H.P, Hanrath P, Franke A. M-mode echocardiography overestimates left ventricular mass in patients with normal left ventricular shape: a comparative study using three-dimensional echocardiography. Eur J Echocardiogr (2003) 4:312–319.[Medline]
  2. Mansencal N, Bordachar P, Chatellier G, Redheuil A, Diebold B, Abergel E. Comparison of accuracy of left ventricular echocardiographic measurements by fundamental imaging versus second harmonic imaging. Am J Cardiol (2003) 91:1037–1039.[CrossRef][Web of Science][Medline]
  3. McGavigan A.D, Dunn F.G, Goodfield N.E. Secondary harmonic imaging overestimates left ventricular mass compared to fundamental echocardiography. Eur J Echocardiogr (2003) 4:178–181.[Abstract/Free Full Text]
  4. Martin F, Mansencal N, Abergel E, Diebold B, Dubourg O. Calcul échocardiographique de la masse ventriculaire gauche en mode TM: évaluation de nouvelles techniques d'imagerie. Arch Mal Cœur Vaiss; 2004; 97: in press.

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This Article
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