Summary
Changes in left ventricular muscle mass may be an important diagnostic or prognostic finding in children with congenital heart defects, but there are no data on normal mass as determined by cross-sectional echocardiography (CSE) in children. Fourteen newborns, 12 infants, and 69 children (1.5–17 years old) with a structurally normal heart were studied. Enddiastolic and end-systolic volume and mass were calculated from biplane-paired echocardiographic imaging planes—apical two-chamber and apical four-chamber views—using both an area/length and a Simpson's rule geometric method. Data were compared with M-mode measurements. There was a good correlation between area/length and Simpson's rule method [r=0.94, standard error (SE) 4 g/m2].
To validate the measurements, interobserver data were gathered and end-diastolic and endsystolic mass measurements were compared. Interobserver variability for the measurements on the echocardiographic recordings was low at 4.8%; for end-diastolic mass the correlation between two observers wasr=0.99 (SE 3.3 g/m2) and for end-systolic massr=0.97 (SE 7.6 g/m2). Correlation between end-systolic and end-diastolic mass was acceptable (r=0.88, SE 5.9 g/m2) for the CSE mass determination, but poor for the M-mode measurements (r=0.51, SE 20.2 g/m2). Similarly, correlation between M-mode mass and mass estimated by CSE was poor, atr=0.58 for end-diastolic andr=0.094 for end-systolic mass. In newborns and infants the ratio of end-diastolic mass to end-diastolic volume was higher than in the older children, mainly because of a smaller ventricular volume in relation to body surface area in this age group.
In the 26 newborns and infants, left ventricular mass was 48.7±10 g/m2 and volume was 34.6±7 ml/m2, yielding a mas to volume ratio of 1.41±0.03. For the 69 children (mean age 7.4±3.8 years), left ventricular mass was 63±10 g/m2 and volume 59±10 ml/m2 with a mass to volume ratio of 1.07±0.2. Left ventricular end-diastolic mass and volume strongly correlated with age (r=0.9) and body surface area (r=0.98 and 0.97, respectively). As CSE is easy to perform and repeatable, these normal values should provide a valuable database for further longitudinal studies of the development of left ventricular mass in patients with various cardiac abnormalities.
Similar content being viewed by others
References
Burke GL, Arcilla RA, Culpepper WS, Webber LS, Chiang YK, Berenson GS (1987) Blood pressure and echocardiographic measures in children: The Bogalusa heart study.Circulation 75:106–114
Byrd BF, Collins W, Hartness O, Kronenberg M (1988) Superior reproducibility of serial left ventricular mass measurements by two-dimensional vs. m-mode echocardiography (abstract).J Am Coll Cardiol 11:146A
Chapman CB, Baker O, Reynolds J, Bonte FJ (1958) Use of biplane cinefluorography for measurement of ventricular volume.Circulation 18:1105–1112
Daniels SR, Meyer RA, Liang Y, Bove KE (1988) Echocardiographically determined left ventricular mass index in normal children, adolescents and adults.J Am Coll Cardiol 12:703–708
Devereux RB, Alonso DR, Lutas EM, Gottlieb GL, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings.Am J Cardiol 57:450–458
Devereux RB (1988) Left ventricular mass in children and adolescents.J Am Coll Cardiol 12:709–710
Douglas P, Berko B, Lesh M, Reichek N (1989) Alterations in diastolic function in response to progressive left ventricular hypertrophy.J Am Coll Cardiol 13:461–467
Feigenbaum H (1975) Echocardiographic examination of the left ventricle.Circulation 51:1–7
Graham TP Jr, Lewis BW, Jarmakani MM, Canent RV, Capp MP (1970) Left heart volume and mass quantification in children with left ventricular pressure overload.Circulation 41:203–212
Graham TP Jr, Jarkamani JM, Canent RV, Morrow MN (1971) Left heart volume estimation in infancy and childhood.Circulation 43:895–904
Graham TP, Franklin RCG, Wyse RKH, Gooch V, Deanfield JE (1986) Left ventricular wall stress and contractile function in childhood: Normal values and comparison of Fontan repair versus palliation only in patients with tricuspid atresia.Circulation 74(Suppl 1):|1-61-69 1–69
Helak JW, Reichek N (1981) Quantitation of human left ventricular mass and volume by two-dimensional echocardiography: In vivo validation.Circulation 63:1398–1407
Kaye HH, Tynan M, Hunter S (1975) Validity of echocardiographic estimates of left ventricular size and performance in infants and children.Br Heart J 37:371–375
Lange PE, Onnasch DGW, Stephan E, Wessel A, Radley-Smith R, Yacoub MH, Regensburger D, Bernhard A, Heintzen PH (1981) Two-stage anatomic correction of complete transposition of the great arteries: Ventricular volumes and muscle mass.Herz 6:336–343
Linhart JW, Mintz GS, Segal BL, Kawai N, Kotler MN (1975) Left ventricular volume measurement by echocardiography. Fact or fiction?Am J Cardiol 36:114–119
Mann DL, Gillam LD, Weyman AE (1986) Cross sectional echocardiographic assessment of regional left ventricular performance and myocardial perfusion.Prog Cardiovasc Dis 19:1–52
Nishikoka K, Mamiya T, Ueda T, Hayashidera T, Mori C, Konishi Y, Tatsuta N, Jarmakani JM (1981) Left ventricular volume characteristics in children with tricuspid atresia before and after surgery.Am J Cardiol 47:1105–1110
Nakano H (1977) Left ventricular volume estimation in normal infants and children.Ann Paediat Jpn 23:39–48
Onnasch DGW, Lange PE, Heintzen PH (1984) Left ventricular muscle volume in children and young adults.Pediatr Cardiol 5:101–106
Rackley CE, Dodge HT, Coble YD Jr, Hay RE (1964) A method for determining left ventricular mass in man.Circulation 29:666–671
Radtke W (1985) Myocardial imaging by digital subtraction angiography for left ventricular mass measurement.Herz 10:215–219
Rein AJJT, Sanders SP, Colan SD, Parness IA, Epstein M (1987) Left ventricular mechanics in the normal newborn.Circulation 76:1029–1036
Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) The committee on M-mode standardization of the American Society of Echocardiography: Recommendations regarding quantitation of M-mode echocardiography: Results of a survey on echocardiographic measurements.Circulation 58:1072–1081
Schieken RM, Clarke WR, Lauer RM (1981) Left ventricular hypertrophy in children with blood pressures in the upper quintile of the distribution: The Muscatine study.Hypertension 3:669–675
Schiller NB, Acquatella H, Ports TA, Drew D, Goerke J, Ringetz H, Silverman NH, Brundage B, Botvinick EH, Boswell R, Carlson E, Parmley WW (1979) Left ventricular volume from paired biplane two-dimensional echocardiography.Circulation 60:547–555
Seliem M, Muster A, Paul M, Benson W Jr (1989) Relation between preoperative left ventricular muscle mass and outcome of the Fontan procedure in patients with tricuspid atresia.J Am Coll Cardiol 14:750–755
Silverman NH, Ports TA, Snider RA, Schiller NB, Carlsson E, Heilbron DC (1980) Determination of left ventricular volume in children: Echocardiographic and angiographic comparisons.Circulation 62:548–557
Wyatt HL, Heng MK, Meerbaum S, Hestenes JD, Cobo JM, Davidson RM, Corday E (1979) Cross-sectional echocardiography I: Analysis of mathematical models for quantifying myocardial mass of the left ventricle in dogs.Circulation 60:1104–1113
Yasui H, Kado H, Yonenaga K, Hisahara M, Ando H, Iwao H, Fukuda S, Mizoguchi Y, Sunagawa H (1989) Arterial switch operation for transposition of the great arteries, with special reference to left ventricular function.J Thorac Cardiovasc Surg 98:601–610
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vogel, M., Staller, W. & Bühlmeyer, K. Left ventricular myocardial mass determined by cross-sectional echocardiography in normal newborns, infants, and children. Pediatr Cardiol 12, 143–149 (1991). https://doi.org/10.1007/BF02238520
Issue Date:
DOI: https://doi.org/10.1007/BF02238520