Karima Addetia1, Tatsuya Miyoshi2, Vivekanandan Amuthan3, Rodolfo Citro4, Masao Daimon5, Pedro Gutierrez Fajardo6, Ravi R Kasliwal7, James N Kirkpatrick8, Mark J Monaghan9, Denisa Muraru10, Kofo O Ogunyankin11, Seung Woo Park12, Ricardo E Ronderos13, Anita Sadeghpour14, Gregory M Scalia15, Masaaki Takeuchi16, Wendy Tsang17, Edwin S Tucay18, Ana Clara Tude Rodrigues19, Yun Zhang20, Niklas Hitschrich21, Michael Blankenhagen21, Markus Degel21, 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. Jeyalakshmi Heart Center, Madurai, India. 4. University of Salerno, Salerno, Italy. 5. University of Tokyo, Tokyo, Japan. 6. Hospital Bernardette, Guadalajara, Mexico. 7. Medanta Medicity, Gurgoan, Haryana, India. 8. University of Washington, Seattle, Washington. 9. King's College Hospital, London, United Kingdom. 10. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy. 11. First Cardiology Consultants Hospital Ikoyi, Lagos, Nigeria. 12. Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea. 13. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 14. Rajaie Cardiovascular Medical Center, IUMS, Tehran, Iran. 15. GenesisCare, Brisbane, Australia. 16. University of Occupational and Environmental Health, Kitakyushu, Japan. 17. Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada. 18. Philippine Heart Center, Quezon City, Philippines. 19. Hospital Israelita Albert Einstein, São Paulo, Brazil. 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: Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using two-dimensional (2D) echocardiography. However, three-dimensional (3D) echocardiography has been shown to be more accurate and reproducible than 2D echocardiography. Current normative reference values for 3D LV analysis are based predominantly on data from North America and Europe. The World Alliance Societies of Echocardiography study was designed to sample normal subjects from around the world to provide more universal global reference ranges. The aim of this study was to assess the worldwide feasibility of LV 3D echocardiography and report on size and functional measurements. METHODS: A total of 2,262 healthy subjects were prospectively enrolled from 19 centers in 15 countries. Three-dimensional LV full-volume data sets were obtained and analyzed offline using vendor-neutral software. Measurements included LV end-diastolic and end-systolic volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), and global circumferential strain. Results were categorized by age (18-40, 41-65, and >65 years), sex, and race. RESULTS: A total of 1,589 subjects (feasibility 70%) had adequate LV data sets for analysis. Mean normal values for indexed end-diastolic volume, end-systolic volume, and LVEF in men and women were 70 ± 15 and 65 ± 12 mL/m2, 28 ± 7 and 25 ± 6 mL/m2, and 60 ± 5% and 62 ± 5%, respectively. Men had larger LV volumes and lower LVEFs than women. GLS and global circumferential strain were higher in magnitude in women. In both sexes, LV volumes were lower and LVEF tended to be higher with increasing age, especially considering the differences between the youngest and oldest age groups. Although GLS was similar across age groups in men, in women, the youngest and middle-age cohorts revealed higher magnitudes of GLS compared with the oldest age group. Global circumferential strain was higher in magnitude at older age in both men and women. Finally, Asians had smaller chamber sizes and higher LVEFs and absolute strain values than both blacks and whites. CONCLUSIONS: Age, sex, and race should be considered when defining normal reference values for LV dimension and functional parameters obtained by 3D echocardiography.
BACKGROUND: Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using two-dimensional (2D) echocardiography. However, three-dimensional (3D) echocardiography has been shown to be more accurate and reproducible than 2D echocardiography. Current normative reference values for 3D LV analysis are based predominantly on data from North America and Europe. The World Alliance Societies of Echocardiography study was designed to sample normal subjects from around the world to provide more universal global reference ranges. The aim of this study was to assess the worldwide feasibility of LV 3D echocardiography and report on size and functional measurements. METHODS: A total of 2,262 healthy subjects were prospectively enrolled from 19 centers in 15 countries. Three-dimensional LV full-volume data sets were obtained and analyzed offline using vendor-neutral software. Measurements included LV end-diastolic and end-systolic volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), and global circumferential strain. Results were categorized by age (18-40, 41-65, and >65 years), sex, and race. RESULTS: A total of 1,589 subjects (feasibility 70%) had adequate LV data sets for analysis. Mean normal values for indexed end-diastolic volume, end-systolic volume, and LVEF in men and women were 70 ± 15 and 65 ± 12 mL/m2, 28 ± 7 and 25 ± 6 mL/m2, and 60 ± 5% and 62 ± 5%, respectively. Men had larger LV volumes and lower LVEFs than women. GLS and global circumferential strain were higher in magnitude in women. In both sexes, LV volumes were lower and LVEF tended to be higher with increasing age, especially considering the differences between the youngest and oldest age groups. Although GLS was similar across age groups in men, in women, the youngest and middle-age cohorts revealed higher magnitudes of GLS compared with the oldest age group. Global circumferential strain was higher in magnitude at older age in both men and women. Finally, Asians had smaller chamber sizes and higher LVEFs and absolute strain values than both blacks and whites. CONCLUSIONS: Age, sex, and race should be considered when defining normal reference values for LV dimension and functional parameters obtained by 3D echocardiography.