Normal Echocardiographic Measurements in a Korean Population Study: Part I. Cardiac Chamber and Great Artery Evaluation

Abstract

BackgroundMeasurement of the cardiac chamber is essential, and current guidelines recommend measuring and reporting values for both sides of the cardiac chamber during echocardiographic evaluation. Normal echocardiographic reference values have been suggested previously, but detailed information about right-sided chambers and values according to gender was not included.MethodsThis is a prospective multicenter (23 centers) study evaluating normal Korean adult subjects using comprehensive echocardiography. We included normal adult subjects (age; 20-79 years old) who had no significant cardiac disorders or illnesses, such as hypertension or diabetes, which could affect cardiac structure and function. We measured the cardiac chamber including both right and left ventricles as well as atria according to current echocardiography guidelines and compared values according to gender and age groups.ResultsA total of 1003 subjects were evaluated and the mean age was 48 ± 16 years. Left ventricular (LV) dimensions increased, but LV volume decreased in older subjects. Right ventricular (RV) area decreased in women and older subjects, and the RV long-axis dimension showed a similar trend. Left atrial (LA) volume increased in men but there were no differences in LA volume index between men and women. The dimension of great arteries increased in men and older subjects.ConclusionSince there were considerable differences between men and women and in the different age groups, and the trends differed significantly between different echo variables, normal echocardiographic cutoff values should be differentially applied based on age and gender.

Adult echocardiographic nomograms: overview, critical review and creation of a software for automatic, fast and easy calculation of normal values

“…Our research highlighted how there was sufficient agreement on criteria of inclusion adopted by latest major studies ( 1 5 -2 3 , 3 8 , 5 1 , 5 2 , 6 3 ) . H y p e r l i p i d e m i a , s y s t e m i c hypertension, diabetes mellitus, lung disease, renal failure, liver failure, genetic syndrome, neuro-muscular disorders, abnormal electrocardiographic and/or echocardiographic findings, connective tissue disease, and poor image quality have been used as exclusion criteria in the majority of works (15)(16)(17)(18)(19)(20)(21)(22)(23)38,51,52,63). Pregnant or lactating women, athletes, and subjects addicted to alcohol were also excluded by a few authors (15,16,60), and some studies also evaluated smoking (15,21,38,82), anaemia and fever (15,16) as exclusion criteria.…”

“…Almost all studies presented data as mean values (plus or minus standard deviation) normalised by gender, age groups and at times indexed by body surface area (BSA) (15)(16)(17)(18)(19)(20)(21)(22)(23)(34)(35)(36)38,50,58,59,61,90,91). A few studies used percentile (35,72,(76)(77)(78)80) and one study employed z scores (41) that are commonly used in the pediatric age group.…”

“…Differences among age groups and gender have been widely studied (15)(16)(17)(20)(21)(22)(23). Influence of body size parameters (i.e., weight, height and body size) has been evaluated only in a few studies (50,81,82).…”

“…Over the last few years , there has been a crescent call for patients specific rather than generic threshold values , leading multiple authors to publish echocardiographic normative data . In particular, four major multi-center studies (the Normal Reference Range for Echocardiography-NORRE-European, The Japanese Normal Values for Echocardiographic Measurement Project-JAMP, The Echocardiographic Measurements in Normal Chinese Adults-Eminca, and The Normal Echocardiographic Measurements in a Korean population-NORMAL-trials) are currently ongoing and normative data for many 2D and a few 3D parameters have been published (15)(16)(17)(18)(19)(20)(21)(22)(23)52). Contemporary, different centers addressed the need of having normative data for new parameters coming from 3D echocardiography (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58) and deformation analysis .…”

“…For instance, for a given male subject of 26 years, 65 kg weight and 168 cm height, LA atrial minimal diameters range of normalities may vary from to 41.8±5.2 (18) to 35.0±4. 6 (16), up to 33.1±4.2 mm (22), according to the nomogram employed. Thus interpretation of nomograms requires knowledge of their accuracy and limitations (6)(7)(8)(9)(10), and similar analysis has never been performed so far.…”