Ethnic-Specific Normative Reference Values for Echocardiographic LA and LV Size, LV Mass, and Systolic Function: The EchoNoRMAL Study.

Pubmed ID: 25981507

Journal: JACC. Cardiovascular imaging

Publication Date: June 1, 2015

MeSH Terms: Humans, Male, Adult, Female, Aged, Aged, 80 and over, United States, Adolescent, Age Factors, Middle Aged, Sex Factors, Young Adult, Systole, Stroke Volume, Ventricular Function, Left, Echocardiography, Heart Ventricles, Reference Values, Heart Atria, Ethnicity

Grants: G9900264, MC_PC_11004

Authors: Poppe KK, Doughty RN, Gardin JM, Hobbs FD, McMurray JJ, Nagueh SF, Senior R, Thomas L, Whalley GA, Aune E, Brown A, Badano LP, Cameron V, Chadha DS, Chahal N, Chien KL, Daimon M, Dalen H, Detrano R, Akif Duzenli M, Ezekowitz J, de Simone G, Di Pasquale P, Fukuda S, Gill PS, Grossman E, Hobbs FD, Kim HK, Kuznetsova T, Leung NK, Linhart A, McDonagh TA, McGrady M, McMurray JJ, Mill JG, Mogelvang R, Muiesan ML, Ng AC, Ojji D, Otterstad JE, Petrovic DJ, Poppe KK, Prendergast B, Rietzschel E, Schirmer H, Schvartzman P, Senior R, Simova I, Sliwa K, Stewart S, Squire IB, Takeuchi M, Thomas L, Whalley GA, Altman DG, Perera R, Poppe KK, Triggs CM, Au Yeung H, Beans Picón GA, Poppe KK, Whalley GA, Anderson T, Dyck J, Ezekowitz JA, Chirinos JA, De Buyzere ML, Gillebert TC, Rietzschel E, Segers P, Van Daele CM, Doughty RN, Poppe KK, Walsh HA, Whalley GA, Izzo R, De Luca N, Trimarco B, de Simone G, Chadha DS, Goel K, Misra A, Chen PC, Chien KL, Lin HJ, Su TC, Detrano R, Cameron V, Richards AM, Troughton R, Mogelvang R, Skov Jensen J, Di Pasquale P, Paterna S, Akif Duzenli M, Hobbs FD, Davies MK, Davis RC, Roalfe A, Calvert M, Davies MK, Davis RC, Freemantle N, Gill PS, Lip GY, Kuznetsova T, Staessen JA, Dargie HJ, Ford I, McDonagh TA, McMurray JJ, Grossman E, Galasko G, Lahiri A, Senior R, Brown A, Carrington M, Krum H, McGrady M, Stewart S, Zeitz C, Blauwet L, Sliwa K, Stewart S, Dalen H, Moelmen Hansen HE, Støylen A, Thorstensen A, Daimon M, Watanabe H, Yoshikawa J, Fukuda S, Kim HK, Leung NK, Linhart A, Chahal N, Chambers JC, Kooner J, Senior R, Davies J, Loke I, Ng L, Squire IB, Aune E, Otterstad JE, Leung DY, Ng AC, Ojji D, Arnold L, Coffey S, d'Arcy J, Hammond C, Mabbett C, Lima C, Loudon M, Pinheiro N, Prendergast B, Reynolds R, Badano LP, Muraru D, Peluso D, Dal Bianco L, Petrovic DJ, Petrovic J, Schvartzman P, Fuchs FD, Katova T, Simova I, Kaku K, Takeuchi M, Boyd A, Chia EM, Thomas L, Schirmer H, Angelo LC, Pereira AC, Krieger JE, Mill JG, Rodrigues SL, Muiesan ML, Paini A, Agabiti Rosei E, Salvetti M

Cite As: Echocardiographic Normal Ranges Meta-Analysis of the Left Heart Collaboration. Ethnic-Specific Normative Reference Values for Echocardiographic LA and LV Size, LV Mass, and Systolic Function: The EchoNoRMAL Study. JACC Cardiovasc Imaging 2015 Jun;8(6):656-65. Epub 2015 May 14.

Studies:

Abstract

OBJECTIVES: This study sought to derive age-, sex-, and ethnic-appropriate adult reference values for left atrial (LA) and left ventricular (LV) dimensions and volumes, LV mass, fractional shortening, and ejection fraction (EF) derived from geographically diverse population studies. BACKGROUND: The current recommended reference values for measurements from echocardiography may not be suitable to the diverse world population to which they are now applied. METHODS: Population-based datasets of echocardiographic measurements from 22,404 adults without clinical cardiovascular or renal disease, hypertension, or diabetes were combined in an individual person data meta-analysis. Quantile regression was used to derive reference values at the 95th percentile (upper reference value [URV]) and fifth percentile (lower reference value [LRV]) of each measurement against age (treated as linear), separately within sex and ethnic groups. RESULTS: The URVs for left ventricular end-diastolic volume (LVEDV), LV end-systolic volume, and LV stroke volume (SV) were highest in Europeans and lowest in South Asians. Important sex and ethnic differences remained after indexation by body surface area or height for these measurements, as well as for the LRV for SV. LVEDV and SV decreased with increasing age for all groups. Importantly, the LRV for EF differed by ethnicity; there was a clear apparent difference between Europeans and Asians. The URVs for LV end-diastolic diameter and LV end-systolic diameter were higher for Europeans than those for East Asian, South Asian, and African people, particularly among men. Similarly, the URVs for LA diameter and volume were highest for Europeans. CONCLUSIONS: Sex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.