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Ethnic-specific normative reference values for echocardiographic LA and LV size, LV mass, and systolic function : the EchoNoRMAL study

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Poppe, K. K., Doughty, R. N., Gardin, J. M., Hobbs, F. D. R., McMurray, J. J. V., Nagueh, S. F., Senior, R., Thomas, L., Whalley, G. A., Aune, E. et al.
(2015) Ethnic-specific normative reference values for echocardiographic LA and LV size, LV mass, and systolic function : the EchoNoRMAL study. JACC : Cardiovascular Imaging, 8 (6). pp. 656-665. doi:10.1016/j.jcmg.2015.02.014 ISSN 1936878X.

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Official URL: http://dx.doi.org/10.1016/j.jcmg.2015.02.014

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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.

Item Type: Journal Article
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH)
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title: JACC : Cardiovascular Imaging
Publisher: Elsevier Inc.
ISSN: 1936878X
Official Date: June 2015
Dates:
DateEvent
June 2015Published
26 February 2015Accepted
Volume: 8
Number: 6
Page Range: pp. 656-665
DOI: 10.1016/j.jcmg.2015.02.014
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)

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