Comparison of Echocardiographic Measures in a Hispanic/Latino Population With the 2005 and 2015 American Society of Echocardiography Reference Limits (The Echocardiographic Study of Latinos)

Abstract

Background Reference limits for echocardiographic quantification of cardiac chambers in Hispanics are not well studied. Methods and Results We examined the reference values of left atrium (LA) and ventricle (LV) structure in a large ethnically diverse Hispanic cohort. Two-dimensional transthoracic echocardiography was performed in 1,818 participants of the Echocardiographic Study of Latinos (ECHO-SOL). Individuals with body mass index ≥30kg/m2, hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation were excluded leaving 525 participants defined as healthy reference-cohort. We estimated 95th weighted percentiles of LV end systolic volume, LV end diastolic volume, relative wall and septal thickness, LV mass and left atrial volume. We then used upper reference limits of the 2005 and 2015 American Society of Echocardiography (ASE) and 95th percentile of reference cohort to classify the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) target population into abnormal and normal. Reference limits were also calculated for each of 6 Hispanic origins. Using ASE 2015 defined reference values we categorized 7%, 21%, 57% and 17% of males and 18%, 29%, 60% and 26% of females as having abnormal LV mass index, relative, septal and posterior wall thickness, respectively. Conversely, 10%, and 11% of males and 4% and 2% of females were classified as having abnormal end-diastolic volume and internal diameter by ASE 2015 cut-offs, respectively. Similar differences were found when we used 2005 ASE cut offs. Several differences were noted in distribution of cardiac structure and volumes among various Hispanic/Latino origins. Cubans had highest values of echocardiographic measures and Central Americans had the lowest. Conclusions This is the first large study that provides normal reference values for cardiac structure. It further demonstrates that a considerable segment of Hispanic/Latinos residing in US may be classified as having abnormal measures of cardiac chambers when 2015 and 2005 ASE reference cut-offs are used.

Heart of Ethnicity

“…The present study by Qureshi et al 10 adds to the body of literature supporting the importance of ethnicity, for whatever reasons, to cardiac structural adaptations in health and disease. Whether this represents nature, nurture, or combination of the 2 will require much additional research to determine.…”

Childhood and adult exposure to secondhand tobacco smoke and cardiac structure and function: results from Echo-SOL

“…Racial and ethnic differences in LV mass, diastolic function, systolic function and myocardial deformation are not completely explained by cardiometabolic risk factors and comorbidities 35. Within Echo-SOL, the average values of LV size and mass are different than what has been reported in non-Hispanic white cohorts of healthy participants 36. Additionally, LV diastolic dysfunction is more highly prevalent in Hispanics/Latinos than in cohorts of non-Hispanic whites 37.…”

Normal percentile curves for left atrial size in healthy children and adolescents

“…It has been demonstrated that ethnicity and genetic factors contribute to explain the variability in LA dimensions. A recent systematic review based on 36 studies (only one with data from South America) including 30 607 children and adolescents underlined the importance of using race‐specific reference ranges for left cardiac chamber dimensions, as well as the need for standardizing echocardiographic methods in deriving the reference ranges .…”

“…However, data from South American populations are scarce and unfortunately; in general terms, subjects from South America have been particularly underrepresented when evaluating cardiac (ie, LA) structure and function to define reference values. 10,16,17 The above is true not only for adults, but also when considering children and adolescents. Furthermore, to our knowledge, the expected (reference) levels for structural and functional LA parameters in children and adolescents from South America are to be assessed.…”

“…Then, at least in theory, differences in LA could be observed between South American subjects and those from other continents. However, data from South American populations are scarce and unfortunately; in general terms, subjects from South America have been particularly underrepresented when evaluating cardiac (ie, LA) structure and function to define reference values . The above is true not only for adults, but also when considering children and adolescents.…”