Author + information
- Received May 9, 2012
- Revision received June 12, 2012
- Accepted July 23, 2012
- Published online December 1, 2012.
- Navtej S. Chahal, MD⁎,†,
- Tiong K. Lim, MD⁎,
- Piyush Jain, MD†,
- John C. Chambers, MD‡,
- Jaspal S. Kooner, MD† and
- Roxy Senior, MD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Prof. Roxy Senior, Department of Cardiovascular Medicine, Royal Brompton Hospital, Sydney Street, SW3 6NP London, United Kingdom
Objectives The purpose of this study was to define age-, sex-, and ethnicity-specific reference values for 3-dimensional echocardiographic (3DE) left ventricular (LV) volumes and LV ejection fraction (LVEF) in a large cohort of European white and Indian Asian subjects.
Background Transthoracic 3DE imaging is recommended for the routine evaluation of LV volumes and function. However, there remains a lack of population-based reference values for 3DE LV volumes and LVEF, hindering adoption of this technique into routine clinical practice.
Methods We identified subjects from the LOLIPOP (London Life Sciences Prospective Population) study who were free of clinical cardiovascular disease, hypertension, and type 2 diabetes. All subjects underwent transthoracic 2-dimensional and 3D echocardiography for quantification of LV end-systolic volume index, LV end-diastolic volume index, and LVEF.
Results 3DE image quality was satisfactory in 978 subjects (89%) for the purposes of LV volumetric analysis. Indexed 3DE LV volumes were significantly smaller in female compared with male subjects and in Indian Asians compared with European whites. Upper limit of normal (mean ± 2 SD) reference values for the LV end-systolic volume index and LV end-diastolic volume index for the 4 ethnicity-sex subgroups were, respectively, as follows: European white men, 29 ml/m2 and 67 ml/m2; Indian Asian men, 26 ml/m2 and 59 ml/m2; European white women, 24 ml/m2 and 58 ml/m2; Indian Asian women, 23 ml/m2 and 55 ml/m2, respectively. Compared with 3DE studies, 2-dimensional echocardiography underestimated the LV end-systolic volume index and LV end-diastolic volume index by an average of 2.0 ml/m2 and 4.7 ml/m2, respectively. LVEF was similar between in all 4 groups and between 2- and 3-dimensional techniques, with a lower cutoff of 52% for the whole cohort.
Conclusions These reference values are based on the largest 3DE study performed to date that should facilitate the standardization of the technique and encourage its adoption for the routine assessment of LV volumes and LVEF in the clinical echocardiography laboratory. This study supports the application of ethnicity-specific reference values for indexed LV volumes.
Dr. Chahal, Dr. Lim, and Dr. Senior are supported by Northwick Park Cardiac Research Fund. Dr. Jain, Dr. Chambers, and Dr. Kooner are supported by British Heart Foundation grant SP/04/002.
- Received May 9, 2012.
- Revision received June 12, 2012.
- Accepted July 23, 2012.
- American College of Cardiology Foundation