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 All the measurements of LV mass depends on:

Estimating the difference between epicardial and


endocardial LV volumes at end diastole.

 Then calculating the mass of this shell using the


known myocardial density
(LV mass = LV myocardial volume× 1.05)
 Linear measures
◦ M-mode
◦ 2D-imaging

 Volumetric measures
◦ Bi-plane Simpson's method
◦ Area length equation

 3D imaging
 Assessment of IVS thickness & LV posterior wall
thickness during end diastole.

 They are reported as wall thickness an used with


ventricular diameter to estimate relative wall
thickness
M-mode:

 Optimize a parasternal long axis view with the septum and


posterior wall lying parallel (or a parasternal short axis mid-
ventricle level ). Drop the M-mode cursor through opposing
walls so that it intersects both at right angles.

 Measure septal and posterior wall thickness at end-diastole.


2D measures

• This follows the same principle as M-mode but relies


on clear 2D images.

• Record a loop of an optimized parasternal long axis or


short axis (mid-ventricle) level. Scroll through to
identify the end diastolic frame.

• Measure septal and posterior wall thickness at end-


diastole.
 In Para-sternal long axis view at (mid papillary level) obtain
measures of LVEDD, IVS, LVPWT

 LV mass= [0.8 × (1.05 × ((LVEDD + PWT+ IVS)3 – (LVEDD)3))] + 0.6 g


 The constant 0.8 and 0.6 improve the accuracy of the basic equation in studies based on post
mortem hearts

 The equation uses the cubed measurements so, minimal


errors in diameter amplified to large difference in volume.
 This method takes no account of abnormal LV morphology
 Linear measures
◦ M-mode
◦ 2D-imaging

 Volumetric measures
◦ Bi-plane Simpson's method
◦ Area length equation

 3D imaging
 We can use biplane Simpson’s method to calculate LV
mass

 Measure total LV volume using Simpson's method by


tracing the epicardial border in apical 4-CH, 2-CH view
at end diastole

 Trace the endocardial border in apical 4-CH, 2-CH view


at end diastole

 The myocardial volume is the difference between the


two volumes
Myocardial mass = Myoc. Volume × Density(1.05)
Area length equation or Truncated ellipsoid model

 Both methods use the same set of measurements in the


end diastole……..
 Total ventricular area , Cavity area (short axis view, mid papillary level)
 LV length (apical 2-CH view)
,and only vary in the equation they use to estimate
volumes
 Area length equation for volume=
(5 x cross-sectional area in PSAX x LV length)/6

 Truncated ellipsoid equation for volume=


8× (cross sectional area in PSAX )2/(3 × π × LV length)
 In Para-short long axis view at (mid papillary level) record a loop
and scroll through to the end diastolic frame

 Trace around the endocardial border and record LV cavity cross


sectional area (do not include papillary muscle)

 Trace around the epicardial border and record LV total cross


sectional area

 Myocardial area is the difference between total cross- sectional


area and cavity cross sectional area

 In non foreshortened apical 2- chamber view record a loop and


identify the end diastolic frame. Measure the distance from apex
to mitral valve annulus record LV length
 In the same way ,3D imaging can be used to
determine mass based on measurement of end-
diastolic cavity volume and total volume.
Classification of LVH

 Physiological LVH: occurs with pregnancy and


athletes

 Primary LVH: primary problem in the myocardium


(e.g HCM, infiltrative cardiomyopathy)

 Secondary LVH: secondary to other pathology (e.g


Ao valve disease, HTN)
I. Description of pattern of hypertrophy (global,
asymmetric)

II. Description of severity (using overall mass, mass


relative to ventricular size)

III. Characterization of related pathology (e.g valve


disease, LVOT obstruction, speckling of amyloid,
localized hypertrophy of tumor)
 PSAX view is good for seeing concentric hypertrophy

 PLAX , Apical 5-CH views are good for assessment of


septal hypertrophy

 Apical, subcostal for picking up of apical hypertrophy

 Comment on abn. texture (speckling) of amyloid “but


notice that it may be affected by contract & gain”
 Localized hypertrophy with abnormal echolucency
may suggest malignant infiltration
 Relative wall thickness = 2 × PWT/LVEDD
 LV mass can be graded to 4 categories:
1) Normal
2) Increased relative wall thickness with increased
mass (concentric LVH)
3) Normal relative wall thickness with increased
mass (eccentric LVH)
4) Increased relative wall thickness with normal
mass (concentric remodeling)
Relative wall thickness >0.42 cm= concentric LVH
Relative wall thickness <0.42 cm= eccentric LVH