Quantitation of Human Left Ventricular Mass and Volume by Two‐dimensional Echocardiography: In Vitro Anatomic Validation

The reliability of two-dimensional echocardiographic (2-DE) quantitation of left ventricular (LV) section area, volume and myocardial mass was assessed in Vitro in 13 postmortem human hearts (LV weight 115–454 g). The pathologic diagnoses included: two normal, five coronary artery disease with infarction and/or aneurysm, three valvular heart disease, two cardiomyopathy and one left ventricular hypertrophy. Hearts were divided into six to 24 short-axis slices (n = 123), imaged in a tank filled with mineral oil and the images planimetered. Calibrated photographs-and actual LV weight served as reference standards. Estimates of section LV cavity volume and myocardial volume were derived by multiplying the appropriate area by section thickness. Section LV mass was obtained by multiplying the myocardial volume by myocardial density. Total LV cavity volume and myocardial mass were derived using Simpson's rule and a short axis area-apical length method. In absolute terms, 2-DE underestimated LV cavity area but accurately estimated LV myocardial area. Excellent correlations were obtained between 2-DE and photographic standards for section cavity area (r = 0.95) and volume (r = 0.90). Simpson's rule (r = 0.97) and area-length (r =− 0.82, r = 0.90, excluding one heart with a bizarrely shaped LV cavity secondary to extensive mural thrombus) estimates of total LV cavity volume also correlated well with reference standards. Similarly, section LV myocardial area correlated well with photographic myocardial area (r = 0.89) and 2-DE and photographic estimates of section LV mass correlated well with actual LV weight (r = 0.92 and 0.96). Consequently, total LV mass obtained with Simpson's rule or the area-length method was highly reliable (r = 0.93 and 0.92, respectively). We conclude that 2-DE can provide reliable estimates of LV volume and mass using the short-axis Simpson's rule or area-length methods and appropriate regression corrections. The area-length method is simple enough to permit clinical application.