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European Journal of Echocardiography 2003 4(3):178-181; doi:10.1016/S1525-2167(02)00164-6
© 2003 by European Society of Cardiology
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Copyright © 2003, The European Society of Cardiology

Secondary harmonic imaging overestimates left ventricular mass compared to fundamental echocardiography

A.D McGavigan*, F.G Dunn and N.E.R Goodfield

Department of Cardiology, Stobhill Hospital, Glasgow, UK

* Address correspondence to: A. D. McGavigan, Department of Cardiology, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, U.K. Tel: +44 141 201 3000; Fax: +44 141 558 5693. amcgav{at}hotmail.com


  Abstract

Aims: The significance of left ventricular hypertrophy in hypertension is well documented, being an independent risk factor for cardiovascular morbidity and mortality. Normal values for left ventricular mass and partition values for left ventricular hypertrophy come from measurements obtained by fundamental echocardiography. Secondary harmonic imaging improves definition of cardiac borders. We hypothesise that this overestimates left ventricular mass compared to fundamental imaging.

Methods and Results: Thirty patients had four parasternal long-axis M-modes performed, two using 1.7 mHz output frequency, receiving at two octaves higher and two using fixed frequency of 2.5 mHz (fundamental imaging). Absolute left ventricular mass and left ventricular mass index were calculated for each modality. Intra-observer variability was <7%. Range on fundamental imaging was 54–264 g/m2 compared to 80–293 g/m2 on secondary harmonic imaging. Mean left ventricular mass index for the group was 118 g/m2 (fundamental imaging) vs 147 g/m2, P<0.001. Twenty-nine of 30 patients had higher left ventricular mass index on secondary harmonic imaging compared to fundamental imaging. Left ventricular mass index was an average of 26% higher on secondary harmonic imaging, range (–7 to 65%) corresponding to average absolute left ventricular mass difference of 55 g. Eleven of 30 patients had left ventricular hypertrophy on fundamental imaging and 17/30 on secondary harmonic imaging.

Conclusion: Secondary harmonic imaging overestimates left ventricular mass index compared to fundamental imaging. Normal left ventricular mass index range is based on equations using fundamental imaging measurements. Management decisions and prognostic implications made on the basis of raised left ventricular mass index using secondary harmonic imaging should be done so with caution.

Keywords: left ventricular mass; secondary harmonic imaging; left ventricular hypertrophy; echocardiography


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