Biventricular Morphology and Function Reference Values Derived From a Large Sample of Healthy Chinese Adults by Magnetic Resonance Imaging

Abstract

Background: Quantification of cardiac structure and function is essential for diagnostic interpretation and clinical decision making. We sought to establish cardiovascular magnetic resonance (CMR) reference values of left and right ventricular (LV and RV) morphology and function based on a large sample of healthy Chinese adults.Methods: Five hundred fifty validated healthy Chinese adults (aged 21–70 years; 323 men) free of hypertension, diabetes, and obesity were included in this study. All the subjects were stratified by gender (men and women) and age decades. On cine CMR, measurements of biventricular end-diastolic, end-systolic, and stroke volumes (EDV, ESV, and SV), ejection fraction (EF), and end-diastolic LV wall thickness (LVWT) and mass (LVM) were obtained.Results: Men had greater LVEDV (111.6 ± 19.8 vs. 94.6 ± 15.6 ml), LVESV (36.5 ± 9.8 vs. 28.2 ± 7.9 ml), LVM (121.1 ± 19.9 vs. 86.1 ± 14.5 g), global end-diastolic LVWT (8.1 ± 1.1 vs. 6.7 ± 1.0 mm), RVEDV (128.0 ± 23.6 vs. 101.7 ± 17.0 ml), and RVESV (53.5 ± 13.7 vs. 36.8 ± 8.9 ml), while women had greater LVEF (67.5 ± 5.4 vs. 70.4 ± 5.7%) and RVEF (58.5 ± 5.2 vs. 64.0 ± 5.3%) (all p < 0.001). For both men and women, age was negatively correlated with LVEDV (r = −0.31 and r = −0.32), LVESV (r = −0.37 and r = −0.47), RVEDV (r = −0.31 and r = −0.29), and RVESV (r = −0.33 and r = −0.44), while it was positively correlated with LVEF (r = 0.28 and r = 0.43) and RVEF (r = 0.28 and r = 0.41) (all p < 0.001). Aging was associated with increasing global end-diastolic LVWT and LVM/LVEDV in both sexes (all p < 0.001). Older age was associated with increasing LVM only in women (r = 0.36, p < 0.001), not in men (r = 0.05, p = 0.359).Conclusions: We systematically provide age-, sex-, and body size-specific CMR reference values for biventricular morphology and function based on a large sample of healthy Chinese adults. Biventricular structure and function are significantly associated with age and sex.

Reference Ranges of Ventricular Morphology and Function in Healthy Chinese Adults: A Multicenter 3 T MRI Study

“…Moreover, in the current study, trabeculae and papillary muscles were excluded from the myocardium, which has been shown to result in larger LVEDV, LVESV, but lower LVEF and LVM. 27,28 Consistent with most previous studies, [8][9][10]19 the current study showed that males had larger biventricular volumes and higher LVM than females, even after indexing by BSA. Likewise, we also observed that EF was higher in females.…”

“…26 These results suggest that it is necessary to establish MRI reference ranges for different ethnicities. In addition, we also found biventricular volumes and indexed parameters in both sexes in the current study were larger than those reported in previous Chinese studies, [6][7][8][9] while the EF was slightly lower. This may be due to the fact that the subjects came from 11 provinces across the country and included a large age span, which reduces selection bias and makes the results more representative.…”

“…These studies have provided useful references for assessment of cardiac structure and function, although most included only single-center data, had small-sample size, or included subjects with a narrow age range. [5][6][7][8][9] The current study is a multicenter study with a larger sample size than these previous similar MRI studies, with subjects from 11 medical centers covering a diverse region in China and with ages up to nearly 90 years. Moreover, technical differences can contribute to between-study heterogeneity and biased results, 10 which may lead to the incompatibility of reference values of ventricular function between centers and limit its clinical application.…”

“…3 However, there is a lack of consensus agreement on the normal reference ranges for ventricular morphology and function evaluated by MRI in Chinese. 4 Normal reference ranges have been reported in a few small cohort or single-center studies, [5][6][7][8][9] but these results are not always representative of the population to which they are applied (especially those of Chinese descent). There are also known population-related differences (eg, sex, age, and ethnicity) in cardiac morphology, and technical heterogeneity (eg, contouring methodology, magnet strength, and postprocessing software package) in morphology assessment, 10 which suggests the need to establish cardiac reference ranges for different ethnicities under controlled technical conditions.…”

Age- and sex-specific reference values of biventricular strain and strain rate derived from a large cohort of healthy Chinese adults: a cardiovascular magnetic resonance feature tracking study

“…Our study population has been described previously [ 20 ]. All the subjects came from the local medical imaging and health screening institution, which provides high-end screening services for eligible community residents, with cardiovascular imaging as one of the key programs.…”