Echocardiographic Measurements in Normal Chinese Adults Focusing on Cardiac Chambers and Great Arteries: A Prospective, Nationwide, and Multicenter Study

doi:10.1016/j.echo.2015.01.022

Journal of the American Society of Echocardiography

Volume 28, Issue 5, May 2015, Pages 570-579

https://doi.org/10.1016/j.echo.2015.01.022 Get rights and content

Background

Currently available echocardiographic reference values are derived mainly from North American and European population studies, and no echocardiographic reference values are available for the Chinese population. The aim of this study was to establish normal values of echocardiographic measurements of the cardiac chambers and great arteries in a nationwide, population-based cohort of healthy Han Chinese adults.

Methods

A total of 1,586 healthy Han Chinese volunteers aged 18 to 79 years were screened at 43 collaborating laboratories throughout China. Standard M-mode and two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries. The impacts of gender and age on all echocardiographic measurements were analyzed.

Results

A total of 1,394 qualified healthy subjects (mean age, 47.3 ± 16.0 years; 678 men) were ultimately enrolled. Except for left ventricular ejection fraction, values of cardiac chamber and great arterial dimensions were significantly higher in men than in women. Most measurements of the atrial and great arterial dimensions, left ventricular wall thickness, and left ventricular mass increased with age in both men and women.

Conclusions

Normal reference values of cardiac dimensional parameters were established for the first time in a nationwide, population-based cohort of healthy Han Chinese adults. Because most of these parameters were found to vary with gender and age, reference values stratified for gender and age should be used in clinical practice.

Section snippets

Study Population

The EMINCA study was initially designed to enroll a total of 1,320 healthy Han Chinese volunteers aged 18 to 79 years, who were divided into six age groups: 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years (n = 220 in each group, 50% men). All participating echocardiographic laboratories were to be from the tertiary hospitals of all provinces and municipalities throughout China except Taiwan and should be accredited by the Chinese Society of Ultrasound in Medicine. The

Study Population

We initially screened 1,586 subjects, and a total of 1,394 healthy volunteers who met the inclusion and exclusion criteria were ultimately enrolled from 43 collaborating laboratories. There were 678 men aged 47.1 ± 16.2 years and 716 women aged 47.5 ± 15.8 years. Demographic data and a total of 34 echocardiographic parameters were obtained from these subjects.

Demographic Features

As shown in Table 1, the mean values of height, weight, body mass index, BSA, SBP, and DBP were significantly higher in men than in women

Discussion

In the present study, normal reference values of a total of 34 echocardiographic parameters focusing on the cardiac chambers and great arteries were reported from 1,394 healthy Han Chinese adults enrolled at 43 collaborating laboratories throughout China, and the impacts of gender and age on all echocardiographic parameters were analyzed. To the best of our knowledge, this is the first prospective, comprehensive, nationwide, multicenter study to define the normal reference values in a large

Conclusions

The EMINCA study is the largest prospective, nationwide, multicenter study, which has established normal reference values of 34 cardiac chamber and great arterial dimensions in healthy Han Chinese adults. Most of the chamber and great arterial dimensions were found to vary with gender and age, and thus reference values stratified for gender and age are recommended for clinical use.

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ChiCTR220056844
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Dans le groupe OG+ OD, 40 patients (67 %) ont eu besoin d’une ablation OD. Le taux de terminaison de la fibrillation auriculaire aiguë était plus élevé dans le groupe OG + OD que dans le groupe OG seul (63,3 % contre 36,7 %, p = 0,003). À la fin du suivi de 12 mois, 42 (70 %) patients du groupe OG + OD n'avaient pas eu de rechute de fibrillation auriculaire / tachycardie auriculaire, contre 31 (51,7 %) patients du groupe OG seul (log-rank p = 0,034; rapport de risques instantanés 0,549 [intervalles de confiance à 95 %, 0,310 – 0,974]). Le taux de récidive de fibrillation auriculaire était également plus élevé dans le groupe OG + OD que dans le groupe OG seul (81,7 % vs 63,3 %, log-rank p = 0,019). L'incidence des événements indésirables était similaire dans les deux groupes (5 % et 3,3 %, respectivement, p = 0,648).
L'ablation OD adjuvante améliore le taux de réussite d'une ablation unique chez les patients atteints de fibrillation auriculaire persistante et d’élargissement de l’oreillette droite.
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MAEF-Net: Multi-attention efficient feature fusion network for left ventricular segmentation and quantitative analysis in two-dimensional echocardiography
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It has fast acquisition speed and no ionizing radiation, with the unique ability to image real-time beating of the heart. Quantification of cardiac chamber size and function is critical for echocardiographic imaging [4]. At present, sonographers generally use an echocardiogram to determine the cardiac phase, and to track the end-diastolic frame (EDF) and the end-systolic frame (ESF) in consecutive cardiac cycles, and then manually delineate the endocardial boundary to calculate LVEF and other functional metrics.
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Correction of Left Ventricular Doppler Echocardiographic Measurements for Physiological Variances Using a Novel Optimized Multivariable Allometric Model in Healthy Chinese Han Adults
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Most left ventricular (LV) Doppler measurements vary significantly with age and gender, making it necessary to correct them for physiological variances. We aimed to verify the hypothesis that different Doppler measurements correlate nonlinearly with different biometric variables raised to different scaling factors and exponents. In this work, a total of 23 LV Doppler parameters were measured in 1224 healthy Chinese adults. An optimized multivariable allometric model (OMAM) and scaling equations were developed in 70% of the subjects (group A), and the reliability of the model and equations was verified using the remaining 30% of the subjects (group B) as well as 183 overweight subjects (group C). The single-variable isometric model (SVIM) with body surface area (BSA) as a scaling variable was used for comparison. Before correction, all 23 LV Doppler parameters correlated significantly with one or more of the biometric variables. In group B, gender differences were found in 47.8% (11/23) of the parameters and were eliminated in 81.8% (9/11) of the parameters after correction with OMAM. The successful correction rate with OMAM was 100% (23/23) in group B and 82.6% (19/23) in group C. New reference values for corrected Doppler measurements independent of biometric variables were established. The SVIM with BSA successfully corrected none of the 23 parameters. In conclusion, different LV Doppler parameters allometrically correlated with one or more of the biometric variables. The novel OMAM developed in this study successfully corrected the effects of the physiological variances of most biometric variables on Doppler measurements in healthy and overweight subjects, and was found to be far superior to the SVIM. However, whether the OMAM equations can be applied to other ethnicities, obese subjects, and pathological conditions requires further investigation.
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Three-dimensional volumetric data sets obtained on transthoracic echocardiography in 748 normal subjects (51% men) were analyzed using commercial MV analysis software (TomTec Imaging Systems) to determine annular and leaflet dimensions and areas. The subjects were divided into groups by sex (378 men and 370 women) and age (18 to 40 years [n = 266], 41 to 65 years [n = 249], and >65 years [n = 233]) to identify sex- and age-related differences. In addition, differences among black, white, and Asian populations were studied. Inter- and intraobserver variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements.
Compared with women, men had larger annular size measurements, larger tenting size parameters, and larger leaflet length and area. Compared with the black and white populations, the Asian population showed significantly smaller mitral annular size. Although many of the age, sex, and race differences in MV parameters were statistically significant, they were comparable with or smaller than the corresponding measurement variability. Indexing to body surface area and height did not eliminate these differences consistently, suggesting that parameters may need to be indexed according to their dimensionality.
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Normal Values of Left Ventricular Size and Function on Three-Dimensional Echocardiography: Results of the World Alliance Societies of Echocardiography Study
2022, Journal of the American Society of Echocardiography
Citation Excerpt :
This has implications for day-to-day clinical practice, especially in the Western hemisphere, where people from all parts of the world live. Specifically, reports from China,25 Japan,11 and India9,10,26 have suggested smaller chamber sizes in these countries compared with white European and American subjects.7,8,12,24,27 However, these results could be confounded, because studies were performed using different equipment with different analysis software and using dissimilar acquisition protocols and operators, so that direct comparisons are difficult.
Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using two-dimensional (2D) echocardiography. However, three-dimensional (3D) echocardiography has been shown to be more accurate and reproducible than 2D echocardiography. Current normative reference values for 3D LV analysis are based predominantly on data from North America and Europe. The World Alliance Societies of Echocardiography study was designed to sample normal subjects from around the world to provide more universal global reference ranges. The aim of this study was to assess the worldwide feasibility of LV 3D echocardiography and report on size and functional measurements.
A total of 2,262 healthy subjects were prospectively enrolled from 19 centers in 15 countries. Three-dimensional LV full-volume data sets were obtained and analyzed offline using vendor-neutral software. Measurements included LV end-diastolic and end-systolic volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), and global circumferential strain. Results were categorized by age (18-40, 41-65, and >65 years), sex, and race.
A total of 1,589 subjects (feasibility 70%) had adequate LV data sets for analysis. Mean normal values for indexed end-diastolic volume, end-systolic volume, and LVEF in men and women were 70 ± 15 and 65 ± 12 mL/m², 28 ± 7 and 25 ± 6 mL/m², and 60 ± 5% and 62 ± 5%, respectively. Men had larger LV volumes and lower LVEFs than women. GLS and global circumferential strain were higher in magnitude in women. In both sexes, LV volumes were lower and LVEF tended to be higher with increasing age, especially considering the differences between the youngest and oldest age groups. Although GLS was similar across age groups in men, in women, the youngest and middle-age cohorts revealed higher magnitudes of GLS compared with the oldest age group. Global circumferential strain was higher in magnitude at older age in both men and women. Finally, Asians had smaller chamber sizes and higher LVEFs and absolute strain values than both blacks and whites.
Age, sex, and race should be considered when defining normal reference values for LV dimension and functional parameters obtained by 3D echocardiography.

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: This work was supported by research grants from the National 973 Basic Research Program (grants 2011CB503906, 2012CB518603, and 2013CB530703), the National High-Tech Research and Development Program of China (grant 2012AA02A510), the Program of Introducing Talents of Discipline to Universities (grant B07035), the State Program of National Natural Science Foundation of China for Innovative Research Group (grant 81321061), the State Key Program of National Natural Science of China (grant 61331001), the International Collaboration and Exchange Program of China (grant 81320108004), and the National Natural Science Foundation of China (grants 81425004, 91339109, 81173251, 81270350, 81300234, 81300217, 81100147, 81170136, 81170275, and 81270403).

: Drs G.-H. Yao, Y. Deng, and Y. Liu contributed equally to this work. See the Appendix for a list of EMINCA investigators.

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Clinical InvestigationEchocardiographic Reference Values in Different PopulationsEchocardiographic Measurements in Normal Chinese Adults Focusing on Cardiac Chambers and Great Arteries: A Prospective, Nationwide, and Multicenter Study

Background

Methods

Results

Conclusions

Section snippets

Study Population

Study Population

Demographic Features

Discussion

Conclusions

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

Ethnicity-related differences in left ventricular function, structure and geometry: a population study of UK Indian Asian and European white subjects

Heart

Clinical Investigation
Echocardiographic Reference Values in Different Populations
Echocardiographic Measurements in Normal Chinese Adults Focusing on Cardiac Chambers and Great Arteries: A Prospective, Nationwide, and Multicenter Study