Laurie Soulat-Dufour1, Karima Addetia1, Tatsuya Miyoshi2, Rodolfo Citro3, Masao Daimon4, Pedro Gutierrez Fajardo5, Ravi R Kasliwal6, James N Kirkpatrick7, Mark J Monaghan8, Denisa Muraru9, Kofo O Ogunyankin10, Seung Woo Park11, Ricardo E Ronderos12, Anita Sadeghpour13, Gregory M Scalia14, Masaaki Takeuchi15, Wendy Tsang16, Edwin S Tucay17, Ana Clara Tude Rodrigues18, Amuthan Vivekanandan19, Yun Zhang20, Markus Diehl21, Marcus Schreckenberg21, Victor Mor-Avi1, Federico M Asch2, Roberto M Lang22. 1. University of Chicago, Chicago, Illinois. 2. MedStar Health Research Institute, Washington, District of Columbia. 3. University of Salerno, Salerno, Italy. 4. The University of Tokyo, Tokyo, Japan. 5. Hospital Bernardette, Guadalajara, Mexico. 6. Medanta Medicity, Gurgaon, India. 7. University of Washington, Seattle, Washington. 8. King's College Hospital, London, United Kingdom. 9. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy. 10. First Cardiology Consultants Hospital Ikoyi, Lagos, Nigeria. 11. Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea. 12. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 13. Rajaie Cardiovascular Medical Center, IUMS, Tehran, Iran. 14. GenesisCare, Brisbane, Australia. 15. University of Occupational and Environmental Health, Kitakyushu, Japan. 16. Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. 17. Philippine Heart Center, Quezon City, Philippines. 18. Hospital Israelita Albert Einstein, São Paulo, Brazil. 19. Jeyalakshmi Heart Center, Madurai, India. 20. Qilu Hospital of Shandong University, Jinan, China. 21. TOMTEC Imaging Systems, Unterschleissheim, Germany. 22. University of Chicago, Chicago, Illinois. Electronic address: rlang@medicine.bsd.uchicago.edu.
Abstract
BACKGROUND: The World Alliance Societies of Echocardiography study is a multicenter, international, prospective, cross-sectional study whose aims were to evaluate healthy adult individuals to establish age- and sex-normative values of echocardiographic parameters and to determine whether differences exist among people from different countries and of different ethnicities. The present report focuses on two-dimensional (2D) and three-dimensional (3D) right atrial (RA) size and function. METHODS: Transthoracic 2D and 3D echocardiographic images were obtained in 2,008 healthy adult individuals evenly distributed among subgroups according to sex (1,033 men, 975 women) and age 18 to 40 years (n = 854), 41 to 65 years (n = 653), and >65 years (n = 501). For ethnicity, 34.9% were white, 41.6% Asian, and 9.7% black. Images were analyzed in a core laboratory according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. RA measurements included 2D dimensions, 2D and 3D RA volumes (RAVs) indexed to body surface area (BSA), emptying fraction (EmF), and global longitudinal strain, including total/reservoir, passive/conduit, and active/contractile phases. Differences among age and sex categories and among countries were also examined. RESULTS: RAVs were larger in men (even after BSA indexing), while 3D total EmF and global longitudinal strain magnitudes were higher in women. For both sexes, there were no significant age-related differences in 2D RAV measurements, but 3D RAV values differed minimally with age, remaining significant after BSA indexing. RA total EmF and reservoir strain and passive EmF and conduit strain magnitude were lower in older groups for both sexes. Interestingly, whereas RA active EmF increased with age, contractile strain magnitude decreased. Considerable geographic variations were identified: Asians of both sexes had significantly lower BSA than non-Asians, and their 2D and 3D end-systolic RAVs were significantly smaller even after BSA indexing. Of note, 2D end-systolic RAVs in this group were considerably lower than normal values provided in the current guidelines. CONCLUSIONS: There is significant sex, age, and geographic variability in normal RA size and function parameters. Current guideline-recommended normal ranges for RA size and function parameters should be adjusted geographically on the basis of the results of this study.
BACKGROUND: The World Alliance Societies of Echocardiography study is a multicenter, international, prospective, cross-sectional study whose aims were to evaluate healthy adult individuals to establish age- and sex-normative values of echocardiographic parameters and to determine whether differences exist among people from different countries and of different ethnicities. The present report focuses on two-dimensional (2D) and three-dimensional (3D) right atrial (RA) size and function. METHODS: Transthoracic 2D and 3D echocardiographic images were obtained in 2,008 healthy adult individuals evenly distributed among subgroups according to sex (1,033 men, 975 women) and age 18 to 40 years (n = 854), 41 to 65 years (n = 653), and >65 years (n = 501). For ethnicity, 34.9% were white, 41.6% Asian, and 9.7% black. Images were analyzed in a core laboratory according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. RA measurements included 2D dimensions, 2D and 3D RA volumes (RAVs) indexed to body surface area (BSA), emptying fraction (EmF), and global longitudinal strain, including total/reservoir, passive/conduit, and active/contractile phases. Differences among age and sex categories and among countries were also examined. RESULTS: RAVs were larger in men (even after BSA indexing), while 3D total EmF and global longitudinal strain magnitudes were higher in women. For both sexes, there were no significant age-related differences in 2D RAV measurements, but 3D RAV values differed minimally with age, remaining significant after BSA indexing. RA total EmF and reservoir strain and passive EmF and conduit strain magnitude were lower in older groups for both sexes. Interestingly, whereas RA active EmF increased with age, contractile strain magnitude decreased. Considerable geographic variations were identified: Asians of both sexes had significantly lower BSA than non-Asians, and their 2D and 3D end-systolic RAVs were significantly smaller even after BSA indexing. Of note, 2D end-systolic RAVs in this group were considerably lower than normal values provided in the current guidelines. CONCLUSIONS: There is significant sex, age, and geographic variability in normal RA size and function parameters. Current guideline-recommended normal ranges for RA size and function parameters should be adjusted geographically on the basis of the results of this study.