title: Calculation of pediatric left ventricular mass: validation and reference values using real-time three-dimensional echocardiography.
abstract: BACKGROUND
  Reference values for left ventricular mass (LVM) are important echocardiographic tools for the follow-up of pediatric patients with cardiac disease. Cardiac magnetic resonance (CMR) imaging is currently regarded as the gold standard. The aims of this study were to validate LVM calculated using real-time three-dimensional echocardiography (RT3DE) and to establish pediatric reference values.
  
  
  METHODS
  For validation, 40 subjects (20 patients) consecutively underwent CMR (3-T TX Achieva, 25 cardiac phases/slice) and RT3DE (iE33 or Vivid E9, four subvolumes) in a single-center approach. The quantification of CMR data by the disk summation method as standard (mean LVM, 84.2 ± 53 g; range, 17.7-231.7 g) was compared with RT3DE. In a multicenter prospective design, 434 healthy children were investigated using standard software (LV-Analysis version 3.1).
  
  
  RESULTS
  In comparison with CMR, RT3DE provided a slight overestimation of LVM of only 2.5 ± 11.3% (r = 0.990, intraclass correlation coefficient = 0.995), and there was low intraobserver (mean, 0.9 ± 7.1%; scatter, 13.2% to -15.0%; r = 0.996; intraclass correlation coefficient = 0.998) and interobserver (mean, 1.5 ± 9.3%; scatter, 17.2% to -20.1%; r = 0.993; intraclass correlation coefficient = 0.996) variability. Feasibility of the multicenter approach was 76%, resulting in 332 healthy children (median age, 10.0 years; range, 0-18 years; group I range, 0-6 years; group II range, 7-18 years) with data sets providing adequate image quality. LVM was correlated with sex (group II), age (r = 0.901), height (r = 0.881), weight (r = 0.876), and body surface area (r = 0.898). Unisex percentiles for 0 to 6 years of age and separated according to gender from 7 to 18 years of age were established. Mean calculation time for RT3DE was <3 min.
  
  
  CONCLUSIONS
  In children, LVM calculation presuming excellent real-time three-dimensional echocardiographic data sets is accurate, quick, and reproducible. The percentiles provided are based on a large sample size and may be useful for clinical practice.
authors.affiliation: Center for Congenital Heart Defects, Heart and Diabetes Center Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany. Electronic address: tlaser@hdz-nrw.de.
authors.forename: Kai Thorsten
authors.initials: KT
authors.lastname: Laser
authors.affiliation: University of Münster, Münster, Germany.
authors.forename: Britta Anna
authors.initials: BA
authors.lastname: Houben
authors.affiliation: Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Körperich
authors.affiliation: Center for Congenital Heart Defects, Heart and Diabetes Center Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Nikolaus Alexander
authors.initials: NA
authors.lastname: Haas
authors.affiliation: Klinik Bad Oexen, Bad Oeynhausen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kelter-Klöpping
authors.affiliation: Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Barth
authors.affiliation: Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Burchert
authors.affiliation: Department of Pediatric Cardiology, Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: DallaPozza
authors.affiliation: Center for Congenital Heart Defects, Heart and Diabetes Center Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Deniz
authors.initials: D
authors.lastname: Kececioglu
authors.affiliation: Department of Pediatric Cardiology, University of Bonn, Bonn, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Herberg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000592:standards*; D005260:Female; D005858:Germany; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards*; D007223:Infant; D007231:Infant, Newborn; D019028:Magnetic Resonance Imaging, Cine / Q000592:standards*; D008297:Male; D009929:Organ Size; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: 3D; Children; Congenital heart disease; Echocardiography; Left ventricular mass