Hena N Patel1, Tatsuya Miyoshi2, Karima Addetia1, Michael P Henry1, 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, Marcus Schreckenberg21, Michael Blankenhagen21, Markus Degel21, Alexander Rossmanith21, 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, Gurgoan, 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, Iran University of Medical Sciences, 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: Assessment of cardiac output (CO) and stroke volume (SV) is essential to understand cardiac function and hemodynamics. These parameters can be examined using three echocardiographic techniques (pulsed-wave Doppler, two-dimensional [2D], and three-dimensional [3D]). Whether these methods can be used interchangeably is unclear. The influence of age, sex, and ethnicity on CO and SV has also not been examined in depth. In this report from the World Alliance of Societies of Echocardiography Normal Values Study, the authors compare CO and SV in healthy adults according to age, sex, ethnicity, and measurement techniques. METHODS: A total of 1,450 adult subjects (53% men) free of heart, lung, and kidney disease were prospectively enrolled in 15 countries, with even distributions among age groups and sex. Subjects were divided into three age groups (young, 18-40 years; middle aged, 41-65 years; and old, >65 years) and three main racial groups (whites, blacks, and Asians). CO and SV were indexed (cardiac index [CI] and SV index [SVI], respectively) to body surface area and height and measured using three echocardiographic methods: Doppler, 2D, and 3D. Images were analyzed at two core laboratories (one each for 2D and 3D). RESULTS: CI and SVI were significantly lower by 2D compared with both Doppler and 3D methods in both sexes. SVI was significantly lower in women than men by all three methods, while CI differed only by 2D. SVI decreased with aging by all three techniques, whereas CI declined only with 2D and 3D. CO and SV were smallest in Asians and largest in whites, and the differences persisted after normalization for body surface area. CONCLUSIONS: The present results provide normal reference values for CO and SV, which differ by age, sex, and race. Furthermore, CI and SVI measurements by the different echocardiographic techniques are not interchangeable. All these factors need to be taken into account when evaluating cardiac function and hemodynamics in individual patients.
BACKGROUND: Assessment of cardiac output (CO) and stroke volume (SV) is essential to understand cardiac function and hemodynamics. These parameters can be examined using three echocardiographic techniques (pulsed-wave Doppler, two-dimensional [2D], and three-dimensional [3D]). Whether these methods can be used interchangeably is unclear. The influence of age, sex, and ethnicity on CO and SV has also not been examined in depth. In this report from the World Alliance of Societies of Echocardiography Normal Values Study, the authors compare CO and SV in healthy adults according to age, sex, ethnicity, and measurement techniques. METHODS: A total of 1,450 adult subjects (53% men) free of heart, lung, and kidney disease were prospectively enrolled in 15 countries, with even distributions among age groups and sex. Subjects were divided into three age groups (young, 18-40 years; middle aged, 41-65 years; and old, >65 years) and three main racial groups (whites, blacks, and Asians). CO and SV were indexed (cardiac index [CI] and SV index [SVI], respectively) to body surface area and height and measured using three echocardiographic methods: Doppler, 2D, and 3D. Images were analyzed at two core laboratories (one each for 2D and 3D). RESULTS: CI and SVI were significantly lower by 2D compared with both Doppler and 3D methods in both sexes. SVI was significantly lower in women than men by all three methods, while CI differed only by 2D. SVI decreased with aging by all three techniques, whereas CI declined only with 2D and 3D. CO and SV were smallest in Asians and largest in whites, and the differences persisted after normalization for body surface area. CONCLUSIONS: The present results provide normal reference values for CO and SV, which differ by age, sex, and race. Furthermore, CI and SVI measurements by the different echocardiographic techniques are not interchangeable. All these factors need to be taken into account when evaluating cardiac function and hemodynamics in individual patients.
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