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The Accuracy of Echocardiographic Assessment of Left Ventricular Size in Children by the 5/6 Area × Length (Bullet) Method


  • Conflicts of interest: None to disclose.

  • Funding: None.

Address for correspondence and reprint requests: James Nielsen, M.D., Mount Sinai School of Medicine, Division of Pediatric Cardiology, Box 1201, One Gustave L. Levy Place, New York, NY 10029. Fax: 1-(212) 534 2659; E-mail:


Introduction: Left ventricular end-diastolic volume (LVEDV) calculation is important in decision making in children with congenital heart disease (CHD). This study examined the accuracy of LVEDV calculation by the formula: 5/6 × area × length (“bullet” method), by comparing echocardiographic (ECHO) LVEDV against cardiac magnetic resonance (CMR). Methods: ECHO and CMR data from 72 consecutive subjects with CHD ≤10 years of age were retrospectively reviewed. Exclusion criteria included: >3 months between examinations; unavailable or poor-quality images. Subxiphoid short- and long-axis echocardiographic images were analyzed. Bullet LVEDV was compared to CMR volumes. Results: Seventeen subjects (median age 5.5 years, range 1–10 years) comprised the study group. ECHO and CMR LVEDV showed an excellent correlation (r = 0.97) and a good agreement with a mean difference (limits of agreement) of −1.0 mL (−13.9 to 11.9 mL). Conclusions: Subxiphoid echocardiographic bullet method of measuring LVEDV shows a good agreement with CMR obtained LV size in young children. (Echocardiography 2010;27:691-695)