Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Accurate assessment of left ventricular (LV) function is crucial in cardiovascular diagnostics.
• Standardized reference ranges for LV strain parameters are essential for reliable interpretation of echocardiographic studies.

Purpose of the Study:

• To determine normal ranges for 2D echocardiographic (2DE) measurements of LV strain in a large cohort of healthy volunteers.
• To account for the influence of age and gender on LV strain values.
• To provide contemporary, applicable reference ranges for clinical use.

Main Methods:

• Enrolled 549 healthy subjects across 22 institutions in the Normal Reference Ranges for Echocardiography (NORRE) study.
• Utilized vendor-independent software for homogeneous 2DE data analysis, minimizing equipment variability.
• Calculated lowest expected values for LV strains and twist using ±1.96 standard deviations from the mean.

Main Results:

• Established reference ranges for LV longitudinal, circumferential, and radial strain, as well as LV twist.
• Demonstrated that longitudinal strain decreases with age, while circumferential and radial strain increase.
• Observed that male gender is associated with lower longitudinal, circumferential, and radial strain.
• Identified inter-vendor variability for circumferential and radial strain, but not for longitudinal strain.

Conclusions:

• The NORRE study provides current, practical 2D echocardiographic reference ranges for LV strain.
• Age- and gender-specific reference values for LV strain are critical for accurate echocardiographic interpretation.
• Longitudinal strain measurements showed consistency across vendors, highlighting its reliability.