Effects of papillary muscles and trabeculae on left ventricular quantification: increased impact of methodological variability in patients with left ventricular hypertrophy

Background Accurate quantification of left ventricular mass and ejection fraction is important for patients with left ventricular hypertrophy. Although cardiac magnetic resonance imaging has been proposed as a standard for these indices, prior studies have variably included papillary muscles and trabeculae in myocardial volume. This study investigated the contribution of papillary muscles and trabeculae to left ventricular quantification in relation to the presence and pattern of hypertrophy. Methods Cardiac magnetic resonance quantification was performed on patients with concentric or eccentric hypertrophy and normal controls (20 per group) using two established methods that included papillary muscles and trabeculae in myocardium (method 1) or intracavitary (method 2) volumes. Results Among all patients, papillary muscles and trabeculae accounted for 10.5% of ventricular mass, with greater contribution with left ventricular hypertrophy than normals (12.6 vs. 6.2%, P < 0.001). Papillary muscles and trabeculae mass correlated with ventricular wall mass (r = 0.53) and end-diastolic volume (r = 0.52; P < 0.001). Papillary muscles and trabeculae inclusion in myocardium (method 1) yielded smaller differences with a standard of mass quantification from linear ventricular measurements than did method 2 (P < 0.001). Method 1 in comparison with method 2 yielded differences in left ventricular mass, ejection fraction and volume in all groups, especially in patients with hypertrophy: the difference in ventricular mass index was three-fold to six-fold greater in hypertrophy than normal groups (P < 0.001). Difference in ejection fraction, greatest in concentric hypertrophy (P < 0.001), was independently related to papillary muscles and trabeculae mass, ventricular wall mass, and smaller ventricular volume (R2 = 0.56, P < 0.001). Conclusion Established cardiac magnetic resonance methods yield differences in left ventricular quantification due to variable exclusion of papillary muscles and trabeculae from myocardium. The relative impact of papillary muscles and trabeculae exclusion on calculated mass and ejection fraction is increased among patients with hypertrophy-associated left ventricular remodeling.

[1]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[2]  R. C. Scott,et al.  Observations on the Assessment of Cardiac Hypertrophy Utilizing a Chamber Partition Technique , 1966, Circulation.

[3]  E. Geiser,et al.  Calculation of left ventricular mass and relative wall thickness. , 1974, Archives of pathology.

[4]  N Reichek,et al.  Echocardiographic Determination of Left Ventricular Mass in Man: Anatomic Validation of the Method , 1977, Circulation.

[5]  G. Diamond,et al.  Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. , 1979, The New England journal of medicine.

[6]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[7]  N. Reichek,et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. , 1986, The American journal of cardiology.

[8]  D E Manyari,et al.  Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. , 1990, The New England journal of medicine.

[9]  Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Series 1: programs and collection procedures. , 1994, Vital and health statistics. Ser. 1, Programs and collection procedures.

[10]  J. Gottdiener,et al.  Magnetic resonance imaging compared to echocardiography to assess left ventricular mass in the hypertensive patient. , 1995, American journal of hypertension.

[11]  D. King,et al.  Freehand three-dimensional echocardiography for measurement of left ventricular mass: in vivo anatomic validation using explanted human hearts. , 1997, Journal of the American College of Cardiology.

[12]  D. Pennell,et al.  Left ventricular function and mass after orthotopic heart transplantation: a comparison of cardiovascular magnetic resonance with echocardiography. , 2000, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[13]  S. Plein,et al.  Steady‐state free precession magnetic resonance imaging of the heart: Comparison with segmented k‐space gradient‐echo imaging , 2001, Journal of magnetic resonance imaging : JMRI.

[14]  E. Fleck,et al.  Functional cardiac MR imaging with steady‐state free precession (SSFP) significantly improves endocardial border delineation without contrast agents , 2001, Journal of magnetic resonance imaging : JMRI.

[15]  E C Madu,et al.  Papillary Muscle Contribution to Ventricular Ejection in Normal and Hypertrophic Ventricles: A Transesophageal Echocardiographic Study , 2001, Echocardiography.

[16]  O. Simonetti,et al.  TrueFISP: Assessment of accuracy for measurement of left ventricular mass in an animal model , 2002, Journal of magnetic resonance imaging : JMRI.

[17]  D. Pennell,et al.  Breath-hold FLASH and FISP cardiovascular MR imaging: left ventricular volume differences and reproducibility. , 2002, Radiology.

[18]  Warren J Manning,et al.  Gender differences and normal left ventricular anatomy in an adult population free of hypertension. A cardiovascular magnetic resonance study of the Framingham Heart Study Offspring cohort. , 2002, Journal of the American College of Cardiology.

[19]  Dudley J Pennell,et al.  Assessment of Left Ventricular Mass by Cardiovascular Magnetic Resonance , 2002, Hypertension.

[20]  Dudley J Pennell,et al.  Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy. , 2002, The American journal of cardiology.

[21]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[22]  Daniel W. Jones,et al.  Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. , 2003, Hypertension.

[23]  A. Hall,et al.  New Gender-Specific Partition Values for ECG Criteria of Left Ventricular Hypertrophy: Recalibration Against Cardiac MRI , 2004, Hypertension.

[24]  Michael Jerosch-Herold,et al.  VENTRICULAR FUNCTION Evaluation of Myocardial Volume Heterogeneity During End-Diastole and End-Systole Using Cine MRI , 2004 .

[25]  J Paul Finn,et al.  Left ventricular mass: manual and automatic segmentation of true FISP and FLASH cine MR images in dogs and pigs. , 2004, Radiology.

[26]  A. Beek,et al.  Accuracy of one- and two-dimensional algorithms with optimal image plane position for the estimation of left ventricular mass: a comparative study using magnetic resonance imaging. , 2004, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[27]  M. Nieminen,et al.  Prognostic significance of left ventricular mass change during treatment of hypertension. , 2004, JAMA.

[28]  B. Sievers,et al.  Journal of Cardiovascular Magnetic Resonance Impact of Papillary Muscles in Ventricular Volume and Ejection Fraction Assessment by Cardiovascular Magnetic Resonance , 2022 .

[29]  M. Nieminen,et al.  Regression of Hypertensive Left Ventricular Hypertrophy by Losartan Compared With Atenolol: The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Trial , 2004, Circulation.

[30]  S. Solomon,et al.  Changes in Ventricular Size and Function in Patients Treated With Valsartan, Captopril, or Both After Myocardial Infarction , 2005, Circulation.

[31]  M. Drazner,et al.  Left Ventricular Hypertrophy Is More Prevalent in Blacks Than Whites in the General Population: The Dallas Heart Study , 2005, Hypertension.

[32]  Olga Bondarenko,et al.  Effect of endocardial trabeculae on left ventricular measurements and measurement reproducibility at cardiovascular MR imaging. , 2005, Radiology.

[33]  Richard B Devereux,et al.  Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[34]  Stefan Neubauer,et al.  Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. , 2005, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[35]  B. Hamm,et al.  Evaluation of global and regional left ventricular function with 16-slice computed tomography, biplane cineventriculography, and two-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging. , 2006, Journal of the American College of Cardiology.

[36]  Michael Jerosch-Herold,et al.  Left Ventricular Papillary Muscle Mass: Relationship to Left Ventricular Mass and Volumes by Magnetic Resonance Imaging , 2006, Journal of computer assisted tomography.

[37]  S. Lai,et al.  Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity. , 2006, AJR. American journal of roentgenology.

[38]  L. Johansson,et al.  The exactness of left ventricular segmentation in cine magnetic resonance imaging and its impact on systolic function values , 2007, Acta radiologica.

[39]  David F Yankelevitz,et al.  Left ventricular papillary muscles and trabeculae are significant determinants of cardiac MRI volumetric measurements: effects on clinical standards in patients with advanced systolic dysfunction. , 2008, International journal of cardiology.