Right Ventricular Volumes and Systolic Function by Cardiac Magnetic Resonance and the Impact of Sex, Age, and Obesity in a Longitudinally Followed Cohort Free of Pulmonary and Cardiovascular Disease

Abstract

R ight ventricular (RV) size and systolic function have diagnostic and prognostic value in multiple cardiovascular and pulmonary disorders. [1][2][3][4] However, because of its substernal position and crescentic shape, the right ventricle has been difficult to characterize using conventional 2-dimensional echocardiography. Cardiac magnetic resonance (CMR) provides highly reproducible measures of RV volumes and systolic function. 5,6 See Editorial by Fent and PleinSee Clinical Perspective CMR is considered the noninvasive gold standard for assessment of the heart. 7 As such, CMR-specific reference values are important for distinguishing pathological states from normal variants. We used a current steady-state free precession (SSFP) CMR imaging sequence to determine normative values for RV size and function in a longitudinally followed, community-based sample of adults free of clinical cardiovascular and pulmonary disease. Prior studies have shown that RV parameters differ between sexes and suggest that they vary with age and body size. We sought to verify these differences Background-Cardiac magnetic resonance is uniquely well suited for noninvasive imaging of the right ventricle. We sought to define normal cardiac magnetic resonance reference values and to identify the main determinants of right ventricular (RV) volumes and systolic function using a modern imaging sequence in a community-dwelling, longitudinally followed cohort free of clinical cardiovascular and pulmonary disease. Methods and Results-The Framingham Heart Study Offspring cohort has been followed since 1971. We scanned 1794Offspring cohort members using steady-state free precession cardiac magnetic resonance and identified a reference group of 1336 adults (64±9 years, 576 men) free of prevalent cardiovascular and pulmonary disease. RV trabeculations and papillary muscles were considered cavity volume. Men had greater RV volumes and cardiac output before and after indexation to body size (all P<0.001). Women had higher RV ejection fraction than men (68±6% versus 64±7%; P<0.0001). RV volumes and cardiac output decreased with advancing age. There was an increase in raw and heightindexed RV measurements with increasing body mass index, but this trend was weakly inverted after indexation of RV volumes to body surface area. Sex, age, height, body mass index, and heart rate account for most of the variability in RV volumes and function in this community-dwelling population. Conclusions-We report sex-specific normative values for RV measurements among principally middle-aged and older adults. RV ejection fraction is greater in women. RV volumes increase with body size, are greater in men, and are smaller in older people. Body surface area seems to be appropriate for indexation of cardiac magnetic resonance-derived RV volumes. (Circ Cardiovasc Imaging. 2016;9:e003810.

Reference values of cardiac ventricular structure and function by steady‐state free‐procession MRI at 3.0T in healthy adult chinese volunteers

“…Normal reference values for ventricular sizes and function by MRI is fundamental for the diagnosis of heart disease. Several studies from different centers (primarily in the USA and Europe) have provided normal reference values for ventricular sizes and function using MRI for healthy subjects without cardiovascular disease or patients with cardiovascular disease of European descent . Age‐ and sex‐based reference values of ventricular sizes and function in a broad age range of the adult population of mainland China are lacking.…”

New Cardiac Magnetic Resonance Reference Ranges for Right Ventricular Volumes and Systolic Function

“…Although the normal RV values reported by the authors represent the most robust currently available using SSFP CMR for middle aged to elderly subjects, they do not apply to younger patients. Indeed, quoted reference ranges for younger subjects in other studies fall outside the 95% confidence intervals reported by Foppa et al 11 As such, the use of alterative reference ranges 12,13 for RV volumes and systolic function in younger adult patients is advised.…”

“…The authors reported increased RVEF with advancing age, increased RV end-diastolic volume but lower RVEF in men versus women, lower RVEF in black versus white individuals as well as higher right ventricular enddiastolic volume and lower RVEF in obese individuals. 8,9 Several other studies 7,10 have provided normal reference ranges for RV volumes and systolic function using contemporaneous SSFP acquisition, but these are on a much smaller scale than the study by Foppa et al 11 in this issue of Circulation: Cardiovascular Imaging.…”

“…In summary, the study by Foppa et al 11 provides normal reference values for RV volumes and systolic function using SSFP CMR. These are the most robust and comprehensive contemporary reference values for middle-aged and elderly patients; however, the use of values specific to younger patients and non-white patients is advised where these are required.…”

Left and right ventricular parameters corrected with threshold-based quantification method in a normal cohort analyzed by three independent observers with various training-degree

“…The right ventricular trabeculation are pronounced, but limited data is available regarding quantitative measurement of these structures in a normal population [9,14,15] or in pathological conditions [6,16]. Large population based studies provide normal RV values excluding small intracavitary structures from RV mass [17][18][19].…”