Size Matters! Impact of Age, Sex, Height, and Weight on the Normal Heart Size

Abstract

Background-Therapeutic decisions in cardiology are determined frequently by cardiac chamber size. To decide whether cardiac dimensions are still in the normal range, reliable reference values are needed. However, published reference values mostly refer to historical cohorts using motion-mode measurements and have not been adjusted for sex or age. The impact of body size was only vaguely addressed. The importance of such adjustments is illustrated by studies, which show that smaller individuals and women are at risk of delayed treatment and impaired outcome when currently used reference values are applied. The aim of the present study was to assess the impact of body size, sex, and age on the normal heart size. Methods and Results-We prospectively studied 622 individuals (52.7% women; 17-91 years; 143-200 cm; 32-240 kg) without cardiac disease by standard transthoracic echocardiography. Multivariable linear regression analyses of the impact of sex, age, height, and weight on cardiac chamber size were performed. By multivariable regression analysis (n=500), all 4 variables independently influenced cardiac chamber size. The validity of cardiac dimensions predicted by the regression model was tested prospectively in a validation cohort (n=122). A calculator is proposed that estimates cardiac dimensions on the basis of the regression analysis. Conclusions-Sex, height, weight, and age significantly affect the normal heart size. These parameters need to be considered when cutoff values indicating the need for treatment or even surgery are established. The present prospective study was intended to assess the impact of body size, sex, and age on the normal heart size. We, furthermore, provide a calculation tool that facilitates the application of the results of our statistical analysis in the individual patient. MethodsBetween November 2008 and June 2012, we prospectively included 622 consecutive individuals (52.7% women) who were referred to our outpatient clinic for a standard transthoracic echocardiogram. Age was limited to ≥17 years.Exclusion criteria comprised a cardiac murmur at auscultation, a history of cardiac disease, such as coronary artery disease, cardiomyopathy, rheumatic disease with cardiac involvement, valvular or congenital heart disease, and hypertension. If more than mild valvular heart disease was present, participants were also excluded from this protocol.Study participants were weighed on a calibrated scale without shoes, jacket, or coat, and height was determined.The ethical committee of the Medical University of Vienna approved the study protocol. All patients gave written informed consent. Echocardiographic MeasurementsStudy participants underwent a comprehensive echocardiographic examination by board-certified physicians in the echocardiographic laboratory of the Medical University of Vienna using high-end scanners, such as Siemens Acuson Sequoia C512 and GE (General Electric) Vivid 7. All measurements were obtained according to current recommendations for cardiac chamber quantification. 29 ...

Reference Ranges for and Determinants of Right Ventricular Area in Healthy Adults by Two-Dimensional Echocardiography

“…However, most subjects of this study were younger than 50 years of age. This finding is confirmed by other recent studies [30,32] which showed a significant positive impact of age on RV size. However, other studies showed no effect of age on RV area [20,28], while D'Oronzio et al [22] observed a weak negative correlation with age.…”

“…If we consider the mean ± 2 SD of our pooled data (prospective study + data from the meta-analysis), we identified 20.5 cm 2 in females and 25 cm 2 in males as the upper limit of reference ranges for healthy adult European/Americans, and 19 and 24 cm 2 in healthy Asian females and males, respectively. Very similar reference ranges have recently been seen in other large studies [30,32] that did not analyse ethnic differences. The high upper limits of reference ranges result from the high SDs and reflect the large variability of RV area when assessed by echocardiography.…”

“…Thus, 18 studies published between 1979 and 2014 with 5,248 healthy subjects were included in the meta-analysis (table 2) [1,5,11,12,19,20,21,22,23,24,25,26,27,28,29,30,31]. Further subgroups, such as RV areas of strength athletes [19] and of different American ethnicities [20] were excluded from the meta-analysis due to a lack of further data.…”

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

“…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. However, in some studies (15,19,38,43,52,54,63,82), inclusion criteria were well defined, in other sufficiently explained (20,21,24,30,50,52,61,67,70,74,76), while in few works the criteria were more generic (23,24,26,58,59,69,73).…”

Correlations of First and Second Heart Sounds with Age, Sex, and Body Mass Index

“…Cardiac dimensions are significantly affected by age, sex, height, and weight [1]. This raises the question if some of the characteristic sounds generated by the heart are also correlated with these parameters.…”