title: Overestimation of left ventricular mass and misclassification of ventricular geometry in heart failure patients by two-dimensional echocardiography in comparison with three-dimensional echocardiography.
abstract: BACKGROUND
  Accurate assessment of left ventricular hypertrophy (LVH) and ventricular geometry is important, especially in patients with heart failure (HF). The aim of this study was to compare the assessment of ventricular size and geometry by 2D and 3D echocardiography in normotensive controls and among HF patients with a normal and a reduced ejection fraction.
  
  
  METHODS
  One hundred eleven patients, including 42 normotensive patients without cardiac disease, 41 hypertensive patients with HF and a normal ejection fraction (HFNEF), and 28 patients with HF and a low ejection fraction (HFLEF), underwent 2DE and freehand 3DE. The differences between 2DE and 3DE derived LVM were evaluated by use of a Bland-Altman plot. Differences in classification of geometric types among the cohort between 2DE and 3DE were determined.
  
  
  RESULTS
  Two-dimensional echocardiography overestimated ventricular mass compared to 3D echocardiography (3DE) among normal (166 +/- 36 vs. 145 +/- 20 gm, P = 0.002), HFNEF (258 +/- 108 vs. 175 +/- 47gm, P < 0.001), and HFLEF (444 +/- 136 vs. 259 +/- 77 gm, P < 0.001) patients. The overestimation of mass by 2DE increased in patients with larger ventricular size. The use of 3DE to assess ventricular geometry resulted in reclassification of ventricular geometric patterns in 76% of patients with HFNEF and in 21% of patients with HFLEF.
  
  
  CONCLUSIONS
  2DE overestimates ventricular mass when compared to 3DE among patients with heart failure with both normal and low ejection fractions and leads to significant misclassification of ventricular geometry in many heart failure patients.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York 10034, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Abramov
authors.forename: Stephen
authors.initials: S
authors.lastname: Helmke
authors.forename: Lyna El-Khoury
authors.initials: Lel-K
authors.lastname: Rumbarger
authors.forename: Donald L
authors.initials: DL
authors.lastname: King
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left