Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from
Steffen E Petersen1, Nay Aung2, Mihir M Sanghvi2
1William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. s.e.petersen@qmul.ac.uk.
Insights
This study establishes the largest reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in healthy Caucasian adults aged 45-74. Findings detail sex and age-specific variations in left and right ventricles and atria.
Area of Science:
- Cardiology
- Medical Imaging
- Biostatistics
Background:
- Cardiovascular magnetic resonance (CMR) is the gold standard for assessing cardiac structure and function.
- Establishing reference ranges is crucial for differentiating normal from pathological cardiac states.
- This study provides the largest CMR-specific reference ranges for healthy Caucasian adults aged 45-74.
Purpose of the Study:
- To establish comprehensive, age- and sex-specific reference ranges for cardiac structure and function.
- To utilize a large cohort of healthy Caucasian adults for robust data derivation.
- To enhance the diagnostic accuracy of cardiovascular magnetic resonance imaging.
Main Methods:
- Utilized UK Biobank data from 5,065 participants undergoing 1.5 Tesla CMR.
- Performed manual analysis of all four cardiac chambers (left ventricle, right ventricle, left atrium, right atrium).
- Excluded participants with non-Caucasian ethnicity, cardiovascular disease, or other confounding conditions, resulting in 804 participants for analysis.
Main Results:
- Left ventricular (LV) volumes were larger in males and decreased with age; LV ejection fraction was higher in females and remained static with age.
- Right ventricular (RV) volumes were larger in males and decreased with age; RV ejection fraction increased with age in females only.
- Atrial (left and right) volumes were generally larger in males, with sex-specific differences in ejection fractions observed.
Conclusions:
- The study presents the largest validated age- and sex-specific reference ranges for cardiac chambers in a normal Caucasian population.
- These ranges are essential for accurate interpretation of CMR findings.
- Provides a critical resource for clinical practice and future cardiovascular research.
Background:
Cardiovascular magnetic resonance (CMR) is the gold standard method for the assessment of cardiac structure and function. Reference ranges permit differentiation between normal and pathological states. To date, this study is the largest to provide CMR specific reference ranges for left ventricular, right ventricular, left atrial and right atrial structure and function derived from truly healthy Caucasian adults aged 45-74.
Methods:
Five thousand sixty-five UK Biobank participants underwent CMR using steady-state free precession imaging at 1.5 Tesla. Manual analysis was performed for all four cardiac chambers. Participants with non-Caucasian ethnicity, known cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Remaining participants formed the healthy reference cohort; reference ranges were calculated and were stratified by gender and age (45-54, 55-64, 65-74).
Results:
After applying exclusion criteria, 804 (16.2%) participants were available for analysis. Left ventricular (LV) volumes were larger in males compared to females for absolute and indexed values. With advancing age, LV volumes were mostly smaller in both sexes. LV ejection fraction was significantly greater in females compared to males (mean ± standard deviation [SD] of 61 ± 5% vs 58 ± 5%) and remained static with age for both genders. In older age groups, LV mass was lower in men, but remained virtually unchanged in women. LV mass was significantly higher in males compared to females (mean ± SD of 53 ± 9 g/m2 vs 42 ± 7 g/m2). Right ventricular (RV) volumes were significantly larger in males compared to females for absolute and indexed values and were smaller with advancing age. RV ejection fraction was higher with increasing age in females only. Left atrial (LA) maximal volume and stroke volume were significantly larger in males compared to females for absolute values but not for indexed values. LA ejection fraction was similar for both sexes. Right atrial (RA) maximal volume was significantly larger in males for both absolute and indexed values, while RA ejection fraction was significantly higher in females.
Conclusions:
We describe age- and sex-specific reference ranges for the left ventricle, right ventricle and atria in the largest validated normal Caucasian population.
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