Left Ventricular Mass Assessment by 1- and 2-Dimensional Echocardiographic Methods in Hemodialysis Patients: Changes in Left Ventricular Volume Using Echocardiography Before and After a Hemodialysis Session

Abstract

Rationale & Objective Left ventricular (LV) mass (LVM) is a predictor of cardiovascular morbidity and mortality and commonly calculated using 1-dimensional (1D) echocardiographic methods. These methods are vulnerable to small measurement errors and LVM may wrongly change according to changes in LV volume (LVV). Less commonly used 2-dimensional (2D) methods can accommodate to the changes in LVV and may be a better alternative among patients receiving hemodialysis (HD) with large fluid fluctuations. Study Design Observational study. Setting & Participants Patients with end-stage kidney disease receiving HD. Exposure One HD session. Analytical Approach Transthoracic echocardiography was performed right before and after HD. LVM was calculated using 1D (Devereux, Penn, and Teichholz) and 2D methods (truncated ellipsoid and area-length). Outcomes Significant differences in LVM after HD. Results We compared dimensions, LVV and LVM, in 53 patients (mean age, 63 ± 15 years; 66% men). For each 1-L increase in ultrafiltration volume (UFV), LV internal diameter decreased 1.1 mm (95% CI, 0.5-1.7 mm; P = 0.001). Patients were divided into 2 groups by the median UFV of 1.6 L. Patients with UFV > 1.6 L had significant smaller LVV and LV internal diameter after HD. LVM calculated using 1D methods decreased according to changes in LVV. Conversely, LVM calculated using 2D methods was not significantly different after HD. No significant change in differences between diastolic − systolic myocardial thickness or LVM as assessed using 1D and 2D methods was observed before and after HD, indicating that LVM remained constant despite HD. Limitations We did not use contrast enhancement, 3-dimensional methods, or cardiac magnetic resonance. Conclusions LVM calculated using 2D methods, truncated ellipsoid and area-length, is less affected by fluctuations in fluid and LVV, in contrast to 1D methods. Complementary LVM calculation using 2D methods is encouraged, especially in patients with large fluid fluctuations in which increased LVM using a 1D method has been detected.

Accuracy of Devereux and Teichholz formulas for left ventricular mass calculation in different geometric patterns: comparison with cardiac magnetic resonance imaging

“…Recent studies questioned the accuracy of the DEV method in patients with concentric LV hypertrophy 7 , 9 , 13 . Both methods (Fig.…”

“…1 , both the DEV and TEICH methods rely on the assumption that the LV is a prolate ellipsoid based on the cubic (CUBE) equation developed and refined by Dodge et al 11 , 12 . Indeed, alternative measurement methods with higher agreement and precision have been proposed for Echo 13 , 14 , but require multiple measurements or depend on image quality, such as in three-dimensional Echo. However, the TEICH method has not been systematically evaluated on a large cohort of patients for its feasibility and accuracy.…”

Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients

“…LV mass quantification by the linear method is prone to wrongly changes according to changes in LV volume. For example, the large fluid shift in hemodialysis patients, which causes significant differences in end-diastolic LV internal diameters, apparently affects LV mass calculations by linear methods, but not by the 2D echocardiographic area-length method [ 18 ].…”

Abdominal Aortic Calcification is an Independent Predictor of Left Ventricular Mass Deterioration in Maintenance Hemodialysis Patients

“…It has been con rmed that increased LVM is closely related to poor prognosis of MHD patients, left ventricular hypertrophy (LVH) is often considered as a surrogate end point for all-cause and cardiovascular mortality outcomes. Paoletti et al followed up 123 MHD patients for 10 years, and found elevated LVMI is the strongest predictor of SCD [16][17] . This study once again proves patients with increased LVMI have higher 5-year mortality.…”