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P27 Background: Left ventricle (LV) hypertrophy is a major risk  factor for mortality and morbidity. Unfortunately, the  echocardiographic evaluation of LV mass from the parasternal (PS)  approach is frequently limited in older, obese or emphysematous  individuals. This poses a selection bias to the epidemiological  assessment of LV hypertrophy. Methods: In order to assess whether the  subcostal (SC) view may reliably substitute the PS view to evaluate LV  mass in older adults, 614 unselected persons aged ≥65 years  participating in a population-based survey on heart failure in the  elderly, and 54 randomly selected healthy individuals 35-64 years old,  underwent a complete echocardiographic examination including M-mode PS  and SC scanning. Results: Overall, both PS and SC views were available  for LV mass estimate (Devereux’s formula) in 314 subjects(age:  69.9±0.5 years, mean±SEM) with normal LV kinetics and sinus rhythm.  The SC view underestimated (p&lt;0.001) LV diastolic dimension (LVDD) and  overestimated (p&lt;0.012) free wall thickness (FWT), whereas septum  thickness was similar in the two views. As a consequence, LV mass was  underestimated from the SC view (76.2±1.2 g/m 2 ) as  compared to the PS view (87.9±1.4 g/m 2 ; p 116 and &gt;104 g/m 2 in men and women,  respectively), based on the PS view. When age, body weight and gender  were entered in multivariate regression models with the SC measures,  the first two variables significantly contributed to the prediction of  both LVDD and FWT, and gender only to the prediction of LVDD. LV mass  was recalculated using measures from the SC view, corrected on the  basis of the regression equations. The corrected value did not differ  from that obtained from the PS view and the sensitivity of the SC view  for the diagnosis of LV hypertrophy increased to 51% with unmodified  specificity (98%). Conclusions: The SC view significantly  underestimates LV mass. However, correction for simple demographic and  anthropometric variables greatly improves its reliability for  estimating LV mass and hypertrophy in unselected older  adults.

Subcostal ecocardiography for the evaluation of left ventricular hypertrophy in older populations.