Download Measurement of Left Ventricular Wall Thickness and

Measurement of Left Ventricular Wall
Thickness and Mass by Eehocardiography
By BART L. TROY, M.D., JOAQUIN POMBO, M.D.,
AND
CHARLES E. RACKLEY, M.D.
SUMMARY
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Echocardiographic measurements of minor axis and wall thickness and calculations
from these two measurements of left ventricular end-diastolic volume and mass were
performed in 24 patients and compared with angiocardiographic measurements of the
same variables in corresponding patients. The echo-measured left ventricular enddiastolic chamber dimension (Dd) correlated closely with the angiographic minor axis
in the AP plane (correlation coefficient 0.87 and SE -+-0.45 cm) and with the minor
axis from the lateral film (r 0.91, SE +0.39 cm). Similar correlations were found
between measurements by these methods of wall thickness (r = 0.89, SE +1.3 mm),
of end-diastolic volume (r 0.94, SE ±30.6 cc), and of left ventricular mass (r 0.88,
SE +49.19 g). The reproducibility of this method was established by independent
recordings and measurements of echo Polaroid films by two observers. The percent
systolic wall thickening, as determined by echocardiography, identified subjects with
ejection fractions greater or less than 0.50. Echocardiography offers a reliable and
reproducible method for measuring left ventricular wall thickness and mass. Finally,
ultrasound may provide an accurate method for measuring systolic wall thickening in
man.
Additional Indexing Words:
Chamber dimensions
Ultrasound
Wall thickness
Ventricular mass
A LTHOUGH interest in the thickness of
the left ventricle was recorded as long
ago as 1724 in pathologic examinations,1
observations on human left ventricular wall
thickness and mass in living man have awaited
the development of quantitative angiocardiography.2-1 This measurement of left ventricular
wall thickness has been related to chamber
Ventricular volume
dimensions and pressure in order to calculate
dynamic events of the myocardium throughout the cardiac cycle.6 In chronic heart
disease the left ventricular mass has been
compared with chamber size, mechanical
work, wall forces, and function of the
ventricle in an effort to understand the
mechanism of cardiac hypertrophy.Y 9 Such
studies have suggested that hypertrophy is a
major compensatory mechanism for the failing
myocardium. Unfortunately, the angiographic
estimation of left ventricular wall thickness
and mass requires cardiac catheterization, and
therefore the frequency of such measurements in the course of chronic heart disease is
limited. Recent studies employing echocardiography have produced estimations of left
ventricular volume10-12 and limited observations on wall thickness and mass.1") 13, 14 In the
present investigation echocardiography was
From the University of Alabama Medical Center,
Myocardial Infarction Research Unit, Birmingham,
Alabama.
Supported in part by Contract PH 43-67-1441 with
the National Institutes of Health, VRS Grant RD
2219, and U. S. Public Health Service Grant HE
11310.
Address for reprints: Charles E. Rackley, M.D.,
Professor of Medicine, University of Alabama Medical
Center, 1919 Seventh Avenue South, Birmingham,
Alabama 35233.
Received June 16, 1971; revision accepted for
publication October 25, 1971.
602
Circulation, Volume XLV, March 1972
MEASUREMENTS BY ECHOCARDIOGRAPHY
utilized to measure left ventricular wall
thickness and mass and changes in the wall
throughout the cardiac cycle, and these
measurements were compared with those
obtained from biplane angiocardiography.
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Methods
Echograms were recorded with a Smith Kline
Ekoline #20 which has a cathode-ray tube with
two display modes. The A mode displays motion
and the intensity of the reflected echo signals
without respect to time. This allows setting of the
time gain control so that echoes from deeper
structures, such as the posterior wall, can be
amplified selectively, with or without amplifying
more proximal structures such as the mitral valve
or the interventricular septum. The B mode
displays the amount of motion in relation to time.
The echo records reported in this study are
Polaroid pictures of the B mode display (see fig.
1.)
The technic used in obtaining these Polaroid
pictures was similar to that described
previously.1' A 12-mm (0.05-inch) diameter
crystal transducer, emitting pulsed ultrasound of
2.25 MHz, was placed parasternally, usually in
the left fourth or fifth intercostal space. In a rare
patient with low diaphragms, a lower intercostal
space was sometimes selected. The ultrasound
beam was directed posteriorly with the examiner
observing the A mode of the cathode-ray tube for
the general location of cardiac structures. Gener-
603
ally, the first characteristic motion seen was the
mitral valve, especially the anterior leaflet.15
Anteriorly, the motion of the interventricular
septum could be seen," requiring only a slight
change in position of the transducer. The
transducer was then directed more laterally
and/or inferiorly to detect the motion of the
posterior leaflet of the mitral valve. Usually, the
posterior wall could be seen just behind the
posterior leaflet or slightly lateral and inferior to
it. In other patients the posterior wall was located
first and the septum identified in a reverse fashion
or by moving the transducer medially to record
the interventricular septum while simultaneously
retaining the posterior wall image. After appropriate adjustments of gain, reject, and sensitivity,
a Polaroid picture was taken of the B mode such
as in figure 1.
The transducer is positioned in the left
parasternal region because this is where the
ultrasound beam traverses the most undistorted
pathway into the heart. In areas of the chest other
than the parasternal region and in the parasternal
region in certain patients with chronic obstructive
lung disease, the lung separates the heart and the
chest wall. In these cases echograms of necessary
quality cannot usually be taken since the air
tissue interfaces in lung scatter the echo
beam.15 16 If recordings cannot be obtained with
a patient supine, the semilateral, lateral, or sitting
position at 30 or 450 may result in ac-ceptable
echograms, presumably by bringing the heart in
closer contact with the chest wall. Similarly,
Figure 1
Ant echocardiographic Polaroid picture. From anterior to posterior are seen chest wall, right
ventricle, interventricular septum, left ventricular chamber, and posterior wall of the left
ventricle. Dd is the end-diastolic, and D. the end-systolic left ventricular chamber dimension.
Circulation, Volume XLV, March 1972
604
TROY ET AL.
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pictures may be taken in certain patients at endtidal expiration when films cannot be made at
other phases of respiration.
Appr-eciation of the characteristic motion of
cardiac structures, the correct angulation of the
transducer, the proper settings of the echocardiographic machine, and the optimal position of the
patient all require practice and experience on the
part of the operator. Thus, several months of
experience may be necessary for proficiency. In
initial attempts of the present study, success in
obtaining pictures for the measurement of wall
thickness and mass was Inot tabulated; however,
echograms in the last nine cases required
examination of 15 patients.
Twenty-four patients with valvular and/or
myocardial disease were studied by echocardiography and biplane angiocardiogr-aphy. The only
criterion for echocardiography was that a patient
be scheduled for left ventricular volume and mass
studies at cardiac catheterization.
Figure 1 shows a negative print of a Polaroid
film of a typical echogram which is a time
exposure of the reflected pulsed ultrasound
signals on an oscilloscope. All Polaroid pictures
LV(C+M) V7-4/3 I7T +
2 2
were of similar quality to figure 1 and allowed the
requisite measurements to be made. From the top
to the bottom of the film in figure 1 are seen,
sequentially, chest wall, part of the right
ventricle, interventricular septum, left ventricular
chamber, and the posterior wall of the left
ventricle. The distance from the left side of the
initerventricular septum to the endocardium of the
posterior wall is the chamber diameter. This
dimension at end-diastole is labeled Ddl and at
end-systole D,. Wall thickness is the distance
from the endocardium to the epicardium of the
posterior wall. WVT( represents the end-diastolic
wall thickness and WT, the enid-svstolic wall
thickness. In the three patients with atrial
fibrillation, six or more cycles were averaged for
these measurements to be made. The two basic
measurements D, and WT(1 are niecessary for the
calculation of left ventricular mass in the method
reported.
Echograms from each patient were read independently by two observers. Each pair of values
on the 24 patients studied was averaged and then
plotted against corresponding angiographic data.
In addition, there were 10 patients who had two
echograms taken at different times by each
examiner. The measurement scale was determined
by a film of dots which vertically were 1 cm apart
anid horizontally 1 sec apart.
The formula for the calculation of enid-diastolic
left ventricular chamber volume from the echocardiogram is
LVCV 4/3 (D,,) (D,,) (2D )
~2
2
2
(1)
where LVCV = end-diastolic left ventricular
chamber volumne in ml anid Dd 2 = one half the
left ventr-icular end-diastolic chamber dimensions.
This is a derivation of the ellipsoid formula used
in calculation of angiographic volumes,2 in which
the echo diameter is assumed to equal the minor
diameter measured from the anteroposterior or
lateral angiocardiograms and the major diameter
is assumed to be twice the minor diameter.
Therefore, the left ventricular volume can be
calculated by cubing the echo minor diameter.12
Such values for left ventricular volume are
systematically slightly smaller than those derived
from the above echo formula and can be corrected
bv a factor of 1.047.
The additioni of the wall thickness measurement at end-diastole to the end-diastolic diameter
allows the calculation of the total left ventricular
volume.
T 2)(2 +WT,)( 2
+WT,)
(2)
where LV (C + M) V = end-diastolic left ventricular chamber plus muscle volume in ml;
Dd/2 = one half the left ventricular end-diastolic
chamber dimension; and WT1 = left ventricular
end-diastolic wall thickness.
The volume of the left ventricular mu-scle and
its mass are then calculated.
LVMV LV (C + M) V - LVCV
(3)
where LVMV left ventricular muscle voluime in
nil; LV (C + M) V - end-diastolic left ventricular chamber plus muscle volume in ml; LVCV enid-diastolic left ventricular chamber volume in
ml.
LV7M -= LVMV x 1.05
(4)
where LVM = left ventricular mass in g;
LNVMV - left ventricular muscle volume; and
1.05 - specific gravity of heart muscle.
In 14 of the 24 echo films, not onily enddiastolic wall thickness (WTd) but also endsystolic wall thickness (WT,) was measured as
shown in figure 1. From these two measurements
of WT, and W/TS, the percent thickening of the
ventricular wall with systole was calculated, and
this value was compared with the angiographical1v determined ejection fraction.
Circulation, Volume XLV. March 1972
MEASUREMENTS BY ECHOCARDIOGRAPHY
The 24 patients had left ventricular biplane
angiography during diagnostic cardiac catheterization with informed consent in accordance with
the regulations of the Human Use Committee.
Left ventricular quantitative angiography and
determinations of chamber dimensions, ejection
fraction, wall thickness, and mass were performed
by previously described imethods.2 5
Results
605
following standard errors: for Dd + 0.24 cm,
for WTd + 1.25 mm, for end-diastolic volume
29.2 cc, and for left ventricular mass
41 g. The second method for establishing
reproducibility was independent measurement
of films taken at different times (8 hours to 30
days apart) in 10 patients by two different
examiners. The standard errors, seen in table
2,
Reproducibility of Echo Measurements
Reproducibility was established in two
(1) by independent measurement of
the same echograms and (2) by independent
measurements of echograms taken at different
times in the same patient. The same echo
pictures in 24 patients were read independently by two examiners. The results given in table
1 demonstrate agreement, as seen in the
ways:
follows: for Dd +(0.17 cm, for
WTTd 1.16 mm, for end-diastolic volume + 19.0 cc, and for mass
36 g.
are
as
Echocardiographic and Angiocardiographic
Data
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The echocardiographic and angiographic
data for the 24 patients are presented in table
3. Table 1 contains the individual echo
readings from which the average echo data in
table 3 were calculated. Comparative plots of
able 1
Measurements and Calculations from the Same Echograms by Two Observers Independently
Dd
(cm)
Case
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
*
4.50
6.70
6.70
5.00
6.00
6.00
6.05
6.60
4.95
5.20
6.10
5.00
7.10
6.90
5.00
6.30
5.20
3.80
5.40
5.10
6.40
7.00
4.70
6.10
t
4.60
7.30
6.75
4.90
6.70
6.10
6.05
6.30
4.80
5.10
6.10
4.65
6.80
6.90
5.25
6.30
5.20
4.00
5.30
5.10
6.30
7.00
4.60
6.20
Mean difference
Standard error
Diff
0.10
0.60
0.05
0.10
0.70
0.10
0
0.10
0.15
0.10
0
0.35
0.30
0
0.23
0
0
0.20
0.10
0
0.10
0
0.10
0.10
0.1458
0.2391
*Bart L. Troy, M.D.
tJoaquin F. Pombo, M.D.
Circulation, Volume XLV, March 1972
*
.5.0
8.0
7.5
8.0
8.5
9.0
7.0
8.0
6.3
7.0
9.0
7.0
10.0
12.0
9.0
10.0
20.0
8.5
3.a
5.5
10.5
6.0
6.5
7.0
Wall thickness
(mm)
t
Diff
4.0
8.5
8.5
10.0
9.0
8.0
4.5
7.5
8.0
8.0
6.5
6.0
9.0
10.0
8.0
10.0
20.0
10.0
3.5
6.0
9.5
6.5
7.0
8.0
1.0
0.5
1.0
2.0
0.5
1.0
2.5
0.5
1.5
1.0
2.5
1.0
1.0
2.0
1.0
0
0
1.5
0
0.5
1.0
0.5
0.5
1.0
1.0
1.24
LVEDV
(cc)
*
91
301
201
125
216
216
221
287
121
141
227
125
358
329
125
250
141
55
157
133
262
343
104
227
LV
t
Diff
97
389
308
6
88
7
7
85
11
0
12
10
8
0
24
44
0
20
0
0
9
8
0
12
0
7
11
15.38
29.20
188
301
227
221
275
111
133
227
101
314
329
145
250
141
64
149
133
250
343
97
238
*
70
251
233
146
218
234
181
245
113
134
242
125
360
423
168
290
521
97
181
99
315
201
102
182
mass
(g)
t
58
216
273
185
287
211
113
221
137
151
167
99
287
341
150
290
521
130
174
108
272
218
107
217
Diff
12
65
40
39
69
23
68
24
24
17
75
26
73
82
18
0
0
33
7
9
43
17
5
35
33.5
40.72
606
TROY ET AL.
Table 2
Measurements and Calculations from Different Echograms Recorded at Different Times in the Same
Patient by Two Observers Independently
Subject
*
Dd
(cm)
t
7.10
6.9C35
4.30
4.60
3.23
3.40
6.60
6.70
6.10
5.7.
6.30
6.70
4.80
4.9.3
3.30
3..10
6.80
7.10
6.00
6.10
MXIean difference
Standard error
1
2
3
4
3
6
7
8
9
10
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*Bart L. Troy,
\Vall thickness
Diff
*
(mm)
t
0.1.3
0.10
0.13
0.10
0.3.3
0.20
0.135
0.20
0.30
0.10
12.0
3. 0
9.0
6.7
7.0
8.0
6.3
7.0
10.0
6.0
9.3
3.0
8.3
6.6
7.0
6.3
6.3
4.3
9.3
8.0
LVEDV
(cc)
Diff
*
t
2.3
0
338
91
143
287
227
301
111
149
338
216
336
97
137
301
190
273
121
133
314
227
0.18
0.17
0.3
0.1
0
1.3
0
2.3
0.3
2.0
0.96
1.16
LV mass
Diff
22
6
12
14
37
26
10
16
44
11
19.8
19.0
*
(gm)
t
446
70
184
202
182
231
106
139
360
149
328
74
181
204
164
189
113
80
314
211
Time
between
Diff
echograms
118
4
3
1 hotir
3 days
1 dav
7 days
3 days
2 days
1 dav
30 days
1 day
2 days
2
18
62
7
39
46
62
38.1
36.0
MI.D.
tJoaquin F. Pombo, M1.1).
echo and angiographic left ventricular enddiastolic minor axes, wall thickness, and enddiastolic volume and mass are seen in figures 2
through 6, respectively.
The average echo end-diastolic chamber
dimension, Dd, is compared with the angiographic minor axis on the AP films in table 3
and figure 2. The correlation coefficient, r, is
0.87 with a standard error of + 0.46 em. When
Dd is compared with the angiographic minor
axis in the lateral film (in table 3 and fig. 3),
the r is 0.91 with a standard error of + 0.39
Cm.
The average echo posterior wall thickness
was compared with the angiographic free wall
thickness in table 3 and figure 4. The
correlation coefficient between them is 0.89
with a standard error of + 1.3 mm.
A comparison of echo and angiographic left
ventricular end-diastolic volume is in table 3
and figure 5. The r value is 0.94 with a
standard error of + 30.6 ml.
Left ventricular mass by both methods is
compared in table 3 and figure 6. The r value
is 0.88 with a standard error of ± 49 g.
Echocardiographic Dynamic Wall Thickness
Table 4 presents the echo wall thickness at
end-diastole and end-systole, the calculated
echo percent systolic wall thickening, and the
angiographic ejection fraction in the corresponding patient. While wall thickness measurements are usually easily possible at enddiastole, it was more difficult to identify
clearly both endocardium and epicardium
simultaneously at end-systole. Thus, it was
possible to measure end-systolic wall thickening by echo in only 14 of 24 patients. A plot of
angiographic ejection fraction versus echocardiographic percent systolic wall thickening is
seen in figure 7. The percent systolic wall
thickening varied from 3 to 100%, the range of
ejection fraction from 0.11 to 0.65, and the
correlation coefficient was 0.87. The data
demonstrate that a systolic wall thickening of
60% or greater is associated with an ejection
fraction greater than 0.50.
Discussion
Since the echocardiographic estimation of
left ventricular chamber volume, wall thickness, and mass is based on two assumptions,
the validity of these assumptions must be
examined. The first assumption is that the
echo chamber diameter is representative of
the anteroposterior and lateral diameters of
the left ventricle. The minor semiaxes by
angiographic technics have been shown to be
similar.2 3 17 18 These findings support the use
of the ellipsoid as an appropriate geometric
Circulation, Volume XLV, March 1972
MEASUREMENTS BY ECHOCARDIOGRAPHY
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TROY ET AL.
21.0 r
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2.0
4.0
6.0
ANCISCRAPHIC MINOR DIAMETER
ON AP FILM
cm
Figure 2
8.0
The echocardiographic left ventricular end-diastolic
chamber dimension, D d' is plotted against the angiographic minor diameter on the anteroposterior film.
figure for the left ventricle and further permit
the technic of single-plane quantitative
angiography. Dd correlated with both anteroposterior and lateral angiographic minor axes.
Therefore, Dd can be used to represent both
8.0r
r= 0.897
p < 0.01
S. E. ± 1.31
as
.
3.0 6.0 9.0 12.0 15.0 18.0 21.0
ANGIOGRAPHIC WALL THICKNESS mm
Figure 4
The angiographic thickness of the free wall of the left
U
ventricle is compared with the echocardiographic
thickness of the posterior wall.
minor axes, or Dd1/2 for both minor semiaxes,
in the echo formula. The second assumption
for echocardiographic measurement of chamber volume is that the major axis or length of
the left ventricle is twice the minor axis.
Observations to support this assumption have
derived from previous studies in echocardiography,12 from uniplanar cineangiography in
0
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ANGIOGRAPHIC MINOR DIAMETER
ON LATERAL FILM cm
Figure 3
S.
mmod
8.0
The echocardiographic left ventricular end-diastolic
chamber dimension, D., is plotted against the angiographic minor diameter on the lateral film.
= +
30.63 cc
0
ANIHRAPHIC LEFT VETRICIIUR
Efl DIASTOLIC VOLUE cc
Figure 5
Angiocardiographic and echocardiographic left ventricular end-diastolic volumes are compared.
Circulation, Volume XLV, March 1972
609
MEASUREMENTS BY ECHOCARDIOGRAPHY
600
500
--c
400
0
9=
300
0
0-
200
__
n=
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r= 0.883
p<0.01
S. E.
0
= +
49.19
gm
Downloaded from http://circ.ahajournals.org/ by guest on April 28, 2017
100
200
300
400
500 600
ANGIOGRAPHIC LEFT VENTRICULAR MASS gm
Figure 6
Angiocardiographic and echocardiographic left
tricuilar masses are conmpared.
v(en-
the right anterior oblique position,1'' and frc)m
analysis of data from large films taken at 6 to
12 films/see in both the anteroposterior a nd
lateral projections.18 Experimental and cliniP cal
observations suggest that under certain con(ditions the chronically enlarged left ventri(cle
may alter the relationship between the minior
and major diameters from an ellipsoid to
spheroid.19-21 If the geometric shape of t he
ventricle should change to a spheroid and if its
volume should be calculated from the equation for an ellipsoid, then the calculated
ventricular volume would be considerably
greater than the actual volume. However, in
the five patients in the present study with very
large angiographically determined left ventricular end-diastolic volumes (from 316 to
396 cc), the echo technic did not consistently
overestimate the left ventricular end-diastolic
volume.
There are certain conditions in which
discrepancies could be expected between the
echo and angiographic measurements of wall
thickness at end-diastole. Angiographic wall
thickness at end-diastole is measured along
the free wall of the left ventricle over a 4-cm
long segment of myocardium.4 In echocardiography the thickness of the posterior wall of
the left ventricle is measured. An increase in
thickness of either the endocardium or pericardium could give a spuriously increased
myocardial wall thickness. A pericardial effusion could produce such a change on angiocardiography, but the echo should detect the
fluid separate from the ventricular wall. Both
a
100r
0
0
0
-0
C-1
801
,=
Table 4
Wall Thickening by Echo Compared with Ang 10ographic Ejection Fraction
0
J-
cE
60L
--A
3C
0~~~~~~
Subject
1
2
3
4
.,
6
7
8
9
10
11
12
13
14
Echo w-all thickness (mm)
EndEnddiastole
systole
9 .5
9.0
8.0
7.0
7.0
.5.0
8.0
8.0
9.5
9.8
14.5
10.5
8.()
12.5
10.0
3
64
31
14
77
100
15.0
14.5
88
8X1
18
86
85
61
69
95
7.5)
11.3
13.0
14.0
9.0
14.5)
6.)
11.0
20.5
7.0
10.5
wvall Angiograpphic
thickening
ejectio]
with systole
fractioin'
Percent
Circulation, Volume XLV, March 1972
0.14
0.60
0.11
0.27
0.51
0.65
0.53
0.56
0.40
0.56
0.5 3
0.61
0.5;3
0.58
f_d
40
/ n
20[
=1 r
/
14
0.869
P<0.01
p
0
S. E.
Oa
U
-
.
.
0.2
0.4
+
0.6
0.8
17
mm
-
1.0
ANGIOGRAPHIC EJECTION FRACTION
Figure 7
The relationship between the angiographic ejection
fraction and the echocardiographic percent systolic
thickening of the posterior wall of the left ventricle
is presented. Subjects with systolic wall thickening of
60% or greater have ejection fraction greater than 0.50.
TROY ET AL.
610
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technics would give high values for wall
thickness with pericardial thickening in the
absence of fluid.
Right ventricular hypertrophy can present a
problem in angiocardiography by contributing
to the left border of the heart on the
anteroposterior projection. Thus, a left ventricular angiogram would show an increased
thickness of the left ventricular free wall since
the outer part of the apparent wall thickening on the angiogram would consist of
the right ventricle. Right ventricular angiocardiography would be necessary to solve this
problem in measurement of wall thickness.4 In
the present series, in patient 9 who had mitral
stenosis, the right ventricular pressure of
70/40 mm Hg may indicate right ventricular
hypertrophy, which may account for the echo
measurement of the posterior wall being 3 mm
less than the angiographic thickness of the
lateral wall of the left ventricle.
Another discrepancy between echo and
angiographic wall thickness could exist in the
presence of an aneurysm of the lateral wall of
the left ventricle. If the aneurysm did not
involve the posterior wall, the posterior wall
thickness measured by echo would be expected to be thicker than the lateral wall thickness
measured by angiography. An additional
problem could arise from the development of
a mural thrombus in an aneurysm in the
lateral wall of the left ventricle. The lateral
wall thickness observed on angiography would
project as spuriously larger than the posterior
wall visualized by echo.
Previous investigations bave reported measurements on the percent systolic wall
thickening by cineangiography and by large
film biplane angiography.
Subjects with
normal ventricular function displayed a greater percentage of thickening of the ventricular
wall from diastole to systole than patients with
depressed ventricular function. These clinical
studies described a range of systolic wall
thickening from 25 to 100%. In the present
study the echocardiographic range of systolic
wall thickness was 3 to 100% and suggests that
the echo and angiographic technics are
including equivalent structures in the measurement of systolic wall thickness. Furthermoore, the correlation between percent systolic
wall thickness and ejection fraction suggests
that systolic change in wall thickness may be a
measure of left ventricular function.
Variations in the amount of systolic wall
thickening have been reported from experimental and clinical studies. Direct methods of
measuring the percent thickening of the
ventricular wall in animals describe lower
values than observed in angiographic studies
in man and animals. 22 27 Mitchell, Wildenthal, and Mullins examined the direct and
angiographic methods by inserting inert beads
into the heart beneath the endocardial layer
and by positioning tantalum clips opposite
these beads on the epicardium.2S Measurements of systolic wall thickening averaged 30%
from the beads and 60% from the angiograms.
Thus, the discrepancies from the two methods
must be explained by the infolding of the
trabeculae which is included in the angiographic wall thickness but not in the method
employing the beads. Although the interpretation of these findings remains debatable, the
infolding of the trabeculae does in part reflect
the extent of thickening of the ventricular
wall.
The correlation between echocardiographic
and angiocardiographic measurements of minor diameter and wall thickness and the calculations of left ventricular end-diastolic volume
and mass support the validity of the echo
method. Reproducibility has been confirmed
by independent measurements of two observers. Finally, a relationship between the percent echo systolic wall thickening and the
angiographic ejection fraction has been described, which differentiates patients with an
ejection fraction of greater or less than 0.50.
These studies suggest that the measurement of
systolic wall thickening by echocardiography
may be a reliable method for determining the
changes in left ventricular wall thickness in
the intact human heart.
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Circulation, Volume XLV. March 1972
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Measurement of Left Ventricular Wall Thickness and Mass by
Echocardiography
BART L. TROY, JOAQUIN POMBO and CHARLES E. RACKLEY
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Circulation. 1972;45:602-611
doi: 10.1161/01.CIR.45.3.602
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX
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