title: Limited utility of the subcostal view for the echocardiographic evaluation of left ventricular mass in epidemiological studies of older persons.
abstract: BACKGROUND
  Epidemiological estimates of left ventricular mass are based on echocardiographic imaging from the parasternal view, which is often unavailable in subjects with obesity or lung disease. This study was undertaken to assess whether the subcostal view is a valid alternative to estimate left ventricular mass in an unselected older population.
  
  
  METHODS
  In a cross-sectional study of all the residents in Dicomano, Italy, aged > or =65 years, echocardiography was performed with a systematic attempt to obtain both the parastermal and the subcostal views.
  
  
  RESULTS
  The parasternal view was missing in 73/614 participants, 48 of whom were imaged from the subcostal view. In participants imaged from both views, the subcostal view underestimated left ventricular cavity dimension and, consequently, left ventricular mass [79.7 (1.3) vs. 93.3 (1.5) g/m2; p<0.001]. Furthermore, the subcostal view was only 25% sensitive for the diagnosis of hypertrophy. Several multivariate regression models, developed in an equation development subgroup and tested in a validation subgroup, failed to correct the prediction of left ventricular mass based on measures taken from the subcostal view, also after inclusion of demographic, anthropometric, and spirometric covariates.
  
  
  CONCLUSIONS
  In unselected older persons, the subcostal view does not improve the accuracy of echocardiographic estimation of left ventricular mass, which remains biased in epidemiological studies.
authors.affiliation: Unit of Gerontology and Geriatrics, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliera Careggi, via delle Oblate, 4, 50141 Florence, Italy. dibari@unifi.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.forename: M
authors.initials: M
authors.lastname: Chiara Cavallini
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Francesca
authors.initials: F
authors.lastname: Innocenti
authors.forename: Walter
authors.initials: W
authors.lastname: De Alfieri
authors.forename: Giorgio J
authors.initials: GJ
authors.lastname: Baldereschi
authors.forename: Melisenda
authors.initials: M
authors.lastname: Chiarlone
authors.forename: Francesca
authors.initials: F
authors.lastname: Salti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pini
authors.forename: Giulio
authors.initials: G
authors.lastname: Masotti
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
mesh_terms: D004452:Echocardiography; D016021:Epidemiologic Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left / Q000502:physiology