Reference Values for Echocardiography in Middle-Aged Population: The Cardiovascular Risk in Young Finns Study
Corresponding Author
Saku Ruohonen Ph.D
Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
Address for correspondence and reprint requests: Saku Ruohonen, Ph.D., Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. Fax: 358 2 333 7270;
E-mail: [email protected]
Search for more papers by this authorJuha W. Koskenvuo M.D., Ph.D.
Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
Search for more papers by this authorMaria Wendelin-Saarenhovi M.D., Ph.D.
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
Search for more papers by this authorMikko Savontaus M.D., Ph.D.
Heart Center, Turku University Hospital, University of Turku, Turku, Finland
Search for more papers by this authorMika Kähönen M.D., Ph.D.
Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
Search for more papers by this authorTomi Laitinen M.D., Ph.D.
Department of Clinical Physiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
Search for more papers by this authorTerho Lehtimäki M.D., Ph.D.
Fimlab Laboratories, Department of Clinical Chemistry, School of Medicine, University of Tampere, Tampere, Finland
Search for more papers by this authorEero Jokinen M.D., Ph.D.
Children's Hospital University, University Central Hospital Helsinki, Helsinki, Finland
Search for more papers by this authorJorma Viikari M.D., Ph.D.
Department of Medicine, University of Turku, Turku, Finland
Division of Medicine, Turku University Hospital, Turku, Finland
Search for more papers by this authorMarkus Juonala M.D., Ph.D.
Department of Medicine, University of Turku, Turku, Finland
Division of Medicine, Turku University Hospital, Turku, Finland
Murdoch Children's Research Institute, Parkville, Vic., Australia
Search for more papers by this authorLeena Taittonen M.D., Ph.D.
Vaasa Central Hospital, Vaasa, Finland
Department of Pediatrics, University of Oulu, Oulu, Finland
Search for more papers by this authorPäivi Tossavainen M.D., Ph.D.
Vaasa Central Hospital, Vaasa, Finland
Department of Pediatrics, University of Oulu, Oulu, Finland
Search for more papers by this authorMerja Kallio M.D., Ph.D.
Vaasa Central Hospital, Vaasa, Finland
Department of Pediatrics, University of Oulu, Oulu, Finland
Search for more papers by this authorJeroen J. Bax M.D., Ph.D.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Search for more papers by this authorOlli Raitakari M.D., Ph.D.
Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
Search for more papers by this authorCorresponding Author
Saku Ruohonen Ph.D
Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
Address for correspondence and reprint requests: Saku Ruohonen, Ph.D., Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. Fax: 358 2 333 7270;
E-mail: [email protected]
Search for more papers by this authorJuha W. Koskenvuo M.D., Ph.D.
Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
Search for more papers by this authorMaria Wendelin-Saarenhovi M.D., Ph.D.
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
Search for more papers by this authorMikko Savontaus M.D., Ph.D.
Heart Center, Turku University Hospital, University of Turku, Turku, Finland
Search for more papers by this authorMika Kähönen M.D., Ph.D.
Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
Search for more papers by this authorTomi Laitinen M.D., Ph.D.
Department of Clinical Physiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
Search for more papers by this authorTerho Lehtimäki M.D., Ph.D.
Fimlab Laboratories, Department of Clinical Chemistry, School of Medicine, University of Tampere, Tampere, Finland
Search for more papers by this authorEero Jokinen M.D., Ph.D.
Children's Hospital University, University Central Hospital Helsinki, Helsinki, Finland
Search for more papers by this authorJorma Viikari M.D., Ph.D.
Department of Medicine, University of Turku, Turku, Finland
Division of Medicine, Turku University Hospital, Turku, Finland
Search for more papers by this authorMarkus Juonala M.D., Ph.D.
Department of Medicine, University of Turku, Turku, Finland
Division of Medicine, Turku University Hospital, Turku, Finland
Murdoch Children's Research Institute, Parkville, Vic., Australia
Search for more papers by this authorLeena Taittonen M.D., Ph.D.
Vaasa Central Hospital, Vaasa, Finland
Department of Pediatrics, University of Oulu, Oulu, Finland
Search for more papers by this authorPäivi Tossavainen M.D., Ph.D.
Vaasa Central Hospital, Vaasa, Finland
Department of Pediatrics, University of Oulu, Oulu, Finland
Search for more papers by this authorMerja Kallio M.D., Ph.D.
Vaasa Central Hospital, Vaasa, Finland
Department of Pediatrics, University of Oulu, Oulu, Finland
Search for more papers by this authorJeroen J. Bax M.D., Ph.D.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Search for more papers by this authorOlli Raitakari M.D., Ph.D.
Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
Search for more papers by this authorAbstract
Background
Population and sex-specific reference limits produced with modern ultrasound equipment are needed for accurate clinical echocardiography diagnostics. We report a comprehensive set of reference limits of cardiac function and dimensions in a group of young and middle-aged Finnish men and women produced by the recommendations of European Society of Echocardiography and American Society of Cardiology.
Methods and Results
Cardiac structure and function was studied in a standardized comprehensive echocardiographic examination in 1,079 healthy volunteers without cardiovascular diseases or major known risk factors participating in the population-based Young Finns study (444 men and 635 women, age range 34 and 49 years). We present sex-specific reference values for echocardiographic parameters reflecting cardiac structure (ventricular and atrial dimensions and volumes, left ventricular wall thickness and mass, aortic root) and function. From the 86 measured parameters, only 7 were not statistically significantly different between sexes.
Conclusion
The Young Finns study provides echocardiographic reference ranges for cardiac structure and function quantification that can be utilized to enhance the accuracy or echocardiography diagnostics. The results emphasize the need for sex-specific assessment for most echocardiographic parameters.
References
- 1Wild PS, Sinning CR, Roth A, et al: Distribution and categorization of left ventricular measurements in the general population: Results from the population-based Gutenberg Heart Study. Circ Cardiovasc Imaging 2010; 3: 604–613.
- 2Kou S, Caballero L, Dulgheru R, et al: Echocardiographic reference ranges for normal cardiac chamber size: Results from the NORRE study. Eur Heart J Cardiovasc Imaging 2014; 15: 680–690.
- 3Chahal NS, Lim TK, Jain P, et al: Population-based reference values for 3D echocardiographic LV volumes and ejection fraction. JACC Cardiovasc Imaging 2012; 5: 1191–1197.
- 4Maragiannis D, Nagueh SF: Echocardiographic evaluation of left ventricular diastolic function: An update. Curr Cardiol Rep 2015; 17: 561.
- 5Lang RM, Bierig M, Devereux RB, et al: Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79–108.
- 6Lang RM, Badano LP, Mor-Avi V, et al: Recommendations for cardiac chamber quantification by echocardiography in adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J – Cardiovasc Imaging. 2015; 16: 233–271.
- 7Raitakari OT, Porkka KV, Taimela S, et al: Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults. The Cardiovascular Risk in Young Finns Study. Am J Epidemiol 1994; 140: 195–205.
- 8Raitakari OT, Juonala M, Kähönen M, et al: Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: The Cardiovascular Risk in Young Finns Study. JAMA 2003; 290: 2277–2283.
- 9Alpert MA: Obesity cardiomyopathy: Pathophysiology and evolution of the clinical syndrome. Am J Med Sci 2001; 321: 225–236.
- 10Yeon SB, Salton CJ, Gona P, et al: Impact of age, sex, and indexation method on MR left ventricular reference values in the framingham heart study offspring cohort. J Magn Reson Imaging 2015; 41: 1038–1045.
- 11Feigenbaum H, Armstrong W, Ryan T: Feigenbaum's Echocardiography. Vol. 2005. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins, 2005.
- 12Osranek M, Bursi F, Bailey KR, et al: Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: Three-decade follow-up. Eur Heart J 2005; 26: 2556–2561.
- 13Hinton RC, Kistler JP, Fallon JT, et al: Influence of etiology of atrial fibrillation on incidence of systemic embolism. Am J Cardiol 1977; 40: 509–513.
- 14Bhave NM, Lang RM: Evaluation of left ventricular structure and function by three-dimensional echocardiography. Curr Opin Crit Care 2013; 19: 387–396.
- 15Moreno J, Pérez de Isla L, Campos N, et al: Right atrial indexed volume in healthy adult population: Reference values for two-dimensional and three-dimensional echocardiographic measurements. Echocardiography 2013; 30: 667–671.
- 16Cioffi G, de Simone G, Mureddu G, et al: Right atrial size and function in patients with pulmonary hypertension associated with disorders of respiratory system or hypoxemia. Eur J Echocardiogr J Work Group Echocardiogr Eur Soc Cardiol 2007; 8: 322–331.
- 17Ebtia M, Murphy D, Gin K, et al: Best method for right atrial volume assessment by two-dimensional echocardiography: Validation with magnetic resonance imaging. Echocardiography 2015; 32: 734–739.
- 18Nagueh SF, Appleton CP, Gillebert TC, et al: Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009; 10: 165–193.
- 19Sharp AS, Tapp RJ, Thom SA, et al: Tissue Doppler E/E’ ratio is a powerful predictor of primary cardiac events in a hypertensive population: An ASCOT substudy. Eur Heart J 2010; 31: 747–752.
- 20Galderisi M, Rapacciuolo A, Esposito R, et al: Site-dependency of the E/e’ ratio in predicting invasive left ventricular filling pressure in patients with suspected or ascertained coronary artery disease. Eur Heart J Cardiovasc Imaging 2013; 14: 555–561.
- 21Chuang ML, Gona P, Hautvast GLTF, et al: CMR reference values for left ventricular volumes, mass, and ejection fraction using computer-aided analysis: The Framingham Heart Study. J Magn Reson Imaging 2014; 39: 895–900.
- 22Dalen H, Thorstensen A, Vatten LJ, et al: Reference values and distribution of conventional echocardiographic Doppler measures and longitudinal tissue Doppler velocities in a population free from cardiovascular disease. Circ Cardiovasc Imaging 2010; 3: 614–622.
Citing Literature
