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Marked variability in published CMR criteria for left ventricular basal slice selection - impact of methodological discrepancies on LV mass quantification
Journal of Cardiovascular Magnetic Resonance volume 15, Article number: P101 (2013)
Left ventricular mass (LVM) quantification by cine-CMR is typically performed by planimetry of contiguous LV short axis images. This approach relies on use of anatomic landmarks or quantitative binary cutoffs to define the basal-most aspect of the LV. Methodological discordance concerning criteria for LV basal slice selection has the potential to alter cine-CMR quantified LVM. This study assessed frequency of methodological variability in published LV basal slice definitions, as well as its impact on cine-CMR quantification of LVM.
A Pubmed search was performed using the terms "left ventricular mass", "left ventricular hypertrophy", "myocardial mass", or "hypertrophy" AND "cardiac MRI", "CMR" or "magnetic resonance imaging" [species: human, language: English, publication date: after 1/1/00]. Manuscripts were reviewed by an AHA/ACC level III CMR trained physician for methodology concerning basal slice criteria; methods were categorized based on quantitative and anatomic criteria as defined in each manuscript. Published methods were then applied to an established registry of CAD patients: Cine-CMR images were planimetered for percent circumferential LV myocardium and basal-most LV short axis slices were assigned using the most common quantitative cutoffs determined by literature review.
129 original research publications that measured LVM by cine-CMR were identified by systematic literature review. Basal slice criteria were unspecified in 35%, included all LV myocardium in a small minority (5%), with the remainder evenly divided in use of anatomic landmarks (30%) or quantitative cutoffs (30%) (Figure 1). Marked variability was present in both published anatomic and quantitative criteria for basal slice definition, with the latter most often defined using a binary cutoff of 50% myocardial circumference during end diastole alone (ED50; 20%), or during both end-diastole and end-systole (EDS50; 8%). Among 150 CAD patients (57±12yo, 83% male, 43% HTN), circumferential extent of basal slice LV myocardium varied: 31% of basal slices analyzed contained LV myocardium comprising <50% chamber circumference (Figure 2A). LVM contained within basal LV slices strongly correlated with circumferential extent of LV myocardium (r=0.57, p<0.001) (Figure 2B). LVM excluded using binary cutoffs constituted 5.4±6.5gm (2.7±3.2 gm/m2) for ED50 and 22.0±10.0gm (11.2±5.0 gm/m2) for EDS50, respectively constituting 3.2% and 13.0% of total LVM as calculated when all CMR-evidenced LV myocardium was included.
Marked variability exists in published CMR literature regarding anatomic and quantitative criteria to define the basal-most LV on short axis cine-CMR. Application of established binary cutoffs frequently excludes LV myocardium from CMR measurements, resulting in 3-13% decrements in calculated LVM.
K23 HL 102249-01, Lantheus Medical Imaging (unrestricted research grant)
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Mullally, J., Goyal, P., Simprini, L.A. et al. Marked variability in published CMR criteria for left ventricular basal slice selection - impact of methodological discrepancies on LV mass quantification. J Cardiovasc Magn Reson 15, P101 (2013). https://doi.org/10.1186/1532-429X-15-S1-P101
- Left Ventricular Mass
- Short Axis Slice
- Marked Variability
- Basal Slice
- Circumferential Extent