Tadafumi Sugimoto1, Raluca Dulgheru1, Anne Bernard1,2, Federica Ilardi1, Laura Contu1, Karima Addetia3, Luis Caballero4, Natela Akhaladze5, George D Athanassopoulos6, Daniele Barone7, Monica Baroni8, Nuno Cardim9, Andreas Hagendorff10, Krasimira Hristova11, Teresa Lopez12, Gonzalo de la Morena4, Bogdan A Popescu13, Marie Moonen1, Martin Penicka14, Tolga Ozyigit15, Jose David Rodrigo Carbonero16, Nico van de Veire17, Ralph Stephan von Bardeleben18, Dragos Vinereanu19, Jose Luis Zamorano20, Yun Yun Go1, Monica Rosca13, Andrea Calin13, Julien Magne21, Bernard Cosyns22, Stella Marchetta1, Erwan Donal23, Gilbert Habib24,25, Maurizio Galderisi26, Luigi P Badano27, Roberto M Lang3, Patrizio Lancellotti1,28. 1. Departments of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, 4000 Liège, Belgium. 2. Cardiology Department, CHU Tours, France et Université de Tours, Tours, France. 3. Department of Medicine, University of Chicago Medical Center, IL, USA. 4. Servicio de Cardiologia, Unidad de Imagen Cardiaca, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain. 5. Echocardiography Laboratory of Adult Cardiology, Department of the JO ANN Medical Center, Tbilisi, Georgia. 6. Noninvasive Diagnostics Department, Onassis Cardiac Surgery Center, Athens, Greece. 7. Laboratory of Cardiovascular Ecography, Cardiology Department, S. Andrea Hospital, La Spezia, Italy. 8. Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana 'G.Monasterio'-Ospedale Del Cuore, Massa, Italy. 9. Echocardiography Laboratory, Hospital da Luz, Lisbon, Portugal. 10. Department of Cardiology-Angiology, Echokardiographie-Labore des Universitätsklinikums AöR, University of Leipzig, Leipzig, Germany. 11. Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, Sofia, Bulgaria. 12. Cardiology Department, Cardiac Imaging Unit, La Paz University Hospital, IdiPAz Research Institute, Madrid, Spain. 13. Carol Davila' University of Medicine and Pharmacy-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania. 14. Cardiovascular Center Aalst, OLV-Clinic, Belgium. 15. VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Istanbul, Turkey. 16. Laboratorio de Ecocardiografia Hospital de Cruces, Barakaldo, Spain. 17. Echocardiography Unit, AZ Maria Middelares Gent, Belgium. 18. Medical Department Cardiology, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Germany. 19. Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. 20. University Alcala, Hospital Ramón y Cajal, Madrid, Spain. 21. CHU Dupuytren, Limoges, France. 22. CHVZ (Centrum voor Hart en Vaatziekten)-Universitair ziekenhuis Brussel; and ICMI (In Vivo Cellular and Molecular Imaging) laboratory, Brussels, Belgium. 23. CIC-IT U 1414, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU RENNES, France. 24. Aix-Marseille Univ, URMITE, Marseille, France. 25. APHM, La Timone Hospital, Cardiology Department, Marseille, France. 26. Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy. 27. Department of Cardiac, Thoracic and Vascular Sciences University of Padova, School of Medicine, Padova, Italy. 28. Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.
Abstract
AIMS: To obtain the normal ranges for 2D echocardiographic (2DE) measurements of left ventricular (LV) strain from a large group of healthy volunteers accounting for age and gender. METHODS AND RESULTS: A total of 549 (mean age: 45.6 ± 13.3 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. 2DE data sets have been analysed with a vendor-independent software package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire the data sets. The lowest expected values of LV strains and twist calculated as ± 1.96 standard deviations from the mean were -16.7% in men and -17.8% in women for longitudinal strain, -22.3% and -23.6% for circumferential strain, 20.6% and 21.5% for radial strain, and 2.2 degrees and 1.9 degrees for twist, respectively. In multivariable analysis, longitudinal strain decreased with age whereas the opposite occurred with circumferential and radial strain. Male gender was associated with lower strain for longitudinal, circumferential, and radial strain. Inter-vendor differences were observed for circumferential and radial strain despite the use of vendor-independent software. Importantly, no intervendor differences were noted in longitudinal strain. CONCLUSION: The NORRE study provides contemporary, applicable 2D echocardiographic reference ranges for LV longitudinal, radial, and circumferential strain. Our data highlight the importance of age- and gender-specific reference values for LV strain. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To obtain the normal ranges for 2D echocardiographic (2DE) measurements of left ventricular (LV) strain from a large group of healthy volunteers accounting for age and gender. METHODS AND RESULTS: A total of 549 (mean age: 45.6 ± 13.3 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. 2DE data sets have been analysed with a vendor-independent software package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire the data sets. The lowest expected values of LV strains and twist calculated as ± 1.96 standard deviations from the mean were -16.7% in men and -17.8% in women for longitudinal strain, -22.3% and -23.6% for circumferential strain, 20.6% and 21.5% for radial strain, and 2.2 degrees and 1.9 degrees for twist, respectively. In multivariable analysis, longitudinal strain decreased with age whereas the opposite occurred with circumferential and radial strain. Male gender was associated with lower strain for longitudinal, circumferential, and radial strain. Inter-vendor differences were observed for circumferential and radial strain despite the use of vendor-independent software. Importantly, no intervendor differences were noted in longitudinal strain. CONCLUSION: The NORRE study provides contemporary, applicable 2D echocardiographic reference ranges for LV longitudinal, radial, and circumferential strain. Our data highlight the importance of age- and gender-specific reference values for LV strain. Published on behalf of the European Society of Cardiology. All rights reserved.
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