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Meta-Analysis of Accuracy of Left Ventricular Mass Measurement by Three-Dimensional Echocardiography

      Left ventricular (LV) hypertrophy is a fundamental prognostic factor in a variety of cardiac diseases. Three-dimensional echocardiography (3DE) has achieved better estimation of LV mass than 2-dimensional echocardiography. However, significant underestimation has often been reported, and no previous study has synthesized these data. The aim of this meta-analysis was to investigate if there has been improvement in the accuracy in LV mass measurement by 3DE over time. Studies comparing LV mass between 3DE and magnetic resonance imaging were eligible. A cumulative meta-analysis was performed to investigate improvement in accuracy, followed by subgroup and meta-regression analysis to reveal factors affecting the bias. A total of 25 studies including 671 comparisons were analyzed. Studies published in or before 2004 showed high heterogeneity (I2 = 69%) and significant underestimation of LV mass by 3DE (−5.7 g, 95% confidence interval −11.3 to −0.2, p = 0.04). Studies published from 2005 to 2007 were still heterogenous (I2 = 60%) but showed less systematic bias (−0.5 g, 95% confidence interval −2.5 to 1.5, p = 0.63). In contrast, studies published in or after 2008 were highly homogenous (I2 = 3%) and showed excellent accuracy (−0.1 g, 95% confidence interval −2.2 to 1.9, p = 0.90). Investigation of factors affecting the bias revealed that evaluation of cardiac patients compared to healthy volunteers led to larger bias (p <0.05). In conclusion, this meta-analysis elucidates the underestimation of LV mass by 3DE, its improvement over the past decade, and factors affecting the bias. These data provide a more detailed basis for improving the accuracy of 3DE, an indispensable step toward further clinical application.
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      References

        • Ghali J.K.
        • Liao Y.
        • Simmons B.
        • Castaner A.
        • Cao G.
        • Cooper R.S.
        The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease.
        Ann Intern Med. 1992; 117: 831-836
        • Keane J.F.
        • Driscoll D.J.
        • Gersony W.M.
        • Hayes C.J.
        • Kidd L.
        • O'Fallon W.M.
        • Pieroni D.R.
        • Wolfe R.R.
        • Weidman W.H.
        Second natural history study of congenital heart defects.
        Circulation. 1993; 87: I16-I27
        • Levy D.
        • Garrison R.J.
        • Savage D.D.
        • Kannel W.B.
        • Castelli W.P.
        Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.
        N Engl J Med. 1990; 322: 1561-1566
        • Haider A.W.
        • Larson M.G.
        • Benjamin E.J.
        • Levy D.
        Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death.
        J Am Coll Cardiol. 1998; 32: 1454-1459
        • Benjamin E.J.
        • Levy D.
        Why is left ventricular hypertrophy so predictive of morbidity and mortality?.
        Am J Med Sci. 1999; 317: 168-175
        • Devereux R.B.
        • Pini R.
        • Aurigemma G.P.
        • Roman M.J.
        Measurement of left ventricular mass: methodology and expertise.
        J Hypertens. 1997; 15: 801-809
        • Mor-Avi V.
        • Sugeng L.
        • Weinert L.
        • MacEneaney P.
        • Caiani E.G.
        • Koch R.
        • Salgo I.S.
        • Lang R.M.
        Fast measurement of left ventricular mass with real-time three-dimensional echocardiography: comparison with magnetic resonance imaging.
        Circulation. 2004; 110: 1814-1818
        • Chuang M.L.
        • Salton C.J.
        • Hibberd M.G.
        • Manning W.J.
        • Douglas P.S.
        Relation between number of component views and accuracy of left ventricular mass determined by three-dimensional echocardiography.
        Am J Cardiol. 2007; 99: 1321-1324
        • Yap S.C.
        • van Geuns R.J.
        • Nemes A.
        • Meijboom F.J.
        • McGhie J.S.
        • Geleijnse M.L.
        • Simoons M.L.
        • Roos-Hesselink J.W.
        Rapid and accurate measurement of LV mass by biplane real-time 3D echocardiography in patients with concentric LV hypertrophy: comparison to CMR.
        Eur J Echocardiogr. 2008; 9: 255-260
        • Oe H.
        • Hozumi T.
        • Arai K.
        • Matsumura Y.
        • Negishi K.
        • Sugioka K.
        • Ujino K.
        • Takemoto Y.
        • Inoue Y.
        • Yoshikawa J.
        Comparison of accurate measurement of left ventricular mass in patients with hypertrophied hearts by real-time three-dimensional echocardiography versus magnetic resonance imaging.
        Am J Cardiol. 2005; 95: 1263-1267
        • Caiani E.G.
        • Corsi C.
        • Sugeng L.
        • MacEneaney P.
        • Weinert L.
        • Mor-Avi V.
        • Lang R.M.
        Improved quantification of left ventricular mass based on endocardial and epicardial surface detection with real time three dimensional echocardiography.
        Heart. 2006; 92: 213-219
        • Altmann K.
        • Shen Z.
        • Boxt L.M.
        • King D.L.
        • Gersony W.M.
        • Allan L.D.
        • Apfel H.D.
        Comparison of three-dimensional echocardiographic assessment of volume, mass, and function in children with functionally single left ventricles with two-dimensional echocardiography and magnetic resonance imaging.
        Am J Cardiol. 1997; 80: 1060-1065
        • Gopal A.S.
        • Keller A.M.
        • Shen Z.
        • Sapin P.M.
        • Schroeder K.M.
        • King Jr, D.L.
        • King D.L.
        Three-dimensional echocardiography: in vitro and in vivo validation of left ventricular mass and comparison with conventional echocardiographic methods.
        J Am Coll Cardiol. 1994; 24: 504-513
        • van den Bosch A.E.
        • Robbers-Visser D.
        • Krenning B.J.
        • McGhie J.S.
        • Helbing W.A.
        • Meijboom F.J.
        • Roos-Hesselink J.W.
        Comparison of real-time three-dimensional echocardiography to magnetic resonance imaging for assessment of left ventricular mass.
        Am J Cardiol. 2006; 97: 113-117
        • De Castro S.
        • Pelliccia A.
        • Caselli S.
        • Di Angelantonio E.
        • Papetti F.
        • Cavarretta E.
        • Carbone I.
        • Francone M.
        • Passariello R.
        • Pandian N.G.
        • Fedele F.
        Remodelling of the left ventricle in athlete's heart: a three dimensional echocardiographic and magnetic resonance imaging study.
        Heart. 2006; 92: 975-976
        • Poutanen T.
        • Ikonen A.
        • Jokinen E.
        • Vainio P.
        • Tikanoja T.
        Transthoracic three-dimensional echocardiography is as good as magnetic resonance imaging in measuring dynamic changes in left ventricular volume during the heart cycle in children.
        Eur J Echocardiogr. 2001; 2: 31-39
        • Bu L.
        • Munns S.
        • Zhang H.
        • Disterhoft M.
        • Dixon M.
        • Stolpen A.
        • Sonka M.
        • Scholz T.D.
        • Mahoney L.T.
        • Ge S.
        Rapid full volume data acquisition by real-time 3-dimensional echocardiography for assessment of left ventricular indexes in children: a validation study compared with magnetic resonance imaging.
        J Am Soc Echocardiogr. 2005; 18: 299-305
        • Pouleur A.C.
        • le Polain de Waroux J.B.
        • Pasquet A.
        • Gerber B.L.
        • Gérard O.
        • Allain P.
        • Vanoverschelde J.L.
        Assessment of left ventricular mass and volumes by three-dimensional echocardiography in patients with or without wall motion abnormalities: comparison against cine magnetic resonance imaging.
        Heart. 2008; 94: 1050-1057
        • Lu X.
        • Xie M.
        • Tomberlin D.
        • Klas B.
        • Nadvoretskiy V.
        • Ayres N.
        • Towbin J.
        • Ge S.
        How accurately, reproducibly, and efficiently can we measure left ventricular indices using M-mode, 2-dimensional, and 3-dimensional echocardiography in children?.
        Am Heart J. 2008; 155: 946-953
        • Jenkins C.
        • Bricknell K.
        • Hanekom L.
        • Marwick T.H.
        Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography.
        J Am Coll Cardiol. 2004; 44: 878-886
        • Soriano B.D.
        • Hoch M.
        • Ithuralde A.
        • Geva T.
        • Powell A.J.
        • Kussman B.D.
        • Graham D.A.
        • Tworetzky W.
        • Marx G.R.
        Matrix-array 3-dimensional echocardiographic assessment of volumes, mass, and ejection fraction in young pediatric patients with a functional single ventricle: a comparison study with cardiac magnetic resonance.
        Circulation. 2008; 117: 1842-1848
        • Riehle T.J.
        • Mahle W.T.
        • Parks W.J.
        • Sallee III, D.
        • Fyfe D.A.
        Real-time three-dimensional echocardiographic acquisition and quantification of left ventricular indices in children and young adults with congenital heart disease: comparison with magnetic resonance imaging.
        J Am Soc Echocardiogr. 2008; 21: 78-83
        • Bicudo L.S.
        • Tsutsui J.M.
        • Shiozaki A.
        • Rochitte C.E.
        • Arteaga E.
        • Mady C.
        • Ramires J.A.
        • Mathias Jr, W.
        Value of real time three-dimensional echocardiography in patients with hypertrophic cardiomyopathy: comparison with two-dimensional echocardiography and magnetic resonance imaging.
        Echocardiography. 2008; 25: 717-726
        • Friedberg M.K.
        • Su X.
        • Tworetzky W.
        • Soriano B.D.
        • Powell A.J.
        • Marx G.R.
        Validation of 3D echocardiographic assessment of left ventricular volumes, mass, and ejection fraction in neonates and infants with congenital heart disease: a comparison study with cardiac MRI.
        Circ Cardiovasc Imaging. 2010; 3: 735-742
        • Qi X.
        • Cogar B.
        • Hsiung M.C.
        • Nanda N.C.
        • Miller A.P.
        • Yelamanchili P.
        • Baysan O.
        • Wu Y.S.
        • Lan G.Y.
        • Ko J.S.
        • Cheng C.H.
        • Lin C.C.
        • Huang C.M.
        • Yin W.H.
        • Young M.S.
        Live/real time three-dimensional transthoracic echocardiographic assessment of left ventricular volumes, ejection fraction, and mass compared with magnetic resonance imaging.
        Echocardiography. 2007; 24: 166-173
        • Antman E.M.
        • Lau J.
        • Kupelnick B.
        • Mosteller F.
        • Chalmers T.C.
        A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts.
        JAMA. 1992; 268: 240-248
        • Shimada Y.J.
        • Shiota M.
        • Siegel R.J.
        • Shiota T.
        Accuracy of right ventricular volumes and function determined by three-dimensional echocardiography in comparison with magnetic resonance imaging: a meta-analysis study.
        J Am Soc Echocardiogr. 2010; 23: 943-953
        • Shimada Y.J.
        • Shiota T.
        A meta-analysis and investigation for the source of bias of left ventricular volumes and function by three-dimensional echocardiography in comparison with magnetic resonance imaging.
        Am J Cardiol. 2011; 107: 126-138