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1. Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study.

Author

Asch FM, Miyoshi T, Addetia K, Citro R, Daimon M, Desale S, Fajardo PG, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Blitz A, and Lang RM

Subjects
Adult, Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Organ Size, Prospective Studies, Reference Values, United States, Echocardiography methods, Ethnicity, Heart Ventricles diagnostic imaging, Racial Groups, Societies, Medical, Stroke Volume physiology, Ventricular Function, Left physiology
Abstract

Background: The World Alliance Societies of Echocardiography (WASE) Normal Values Study evaluates individuals from multiple countries and races with the aim of describing normative values that could be applied to the global community worldwide and to determine differences and similarities among people from different countries and races. The present report focuses specifically on two-dimensional (2D) left ventricular (LV) dimensions, volumes, and systolic function., Methods: The WASE Normal Values Study is a multicenter international, observational, prospective, cross-sectional study of healthy adult individuals. Participants recruited in each country were evenly distributed among six predetermined subgroups according to age and gender. Comprehensive 2D transthoracic echocardiograms were acquired and analyzed following strict protocols based on recent American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Analysis was performed at the WASE 2D core laboratory and included 2D LV dimensions, LV volumes, and LV ejection fraction (LVEF) by the biplane Simpson method and global longitudinal strain (GLS)., Results: Two thousand eight subjects were enrolled in 15 countries. The median age was 45 years (interquartile range, 32-65 years), 42.8% were white, 41.8% were Asian, and 9.7% were black. LV dimensions and volumes were larger in male subjects, while LVEF and GLS were higher in female subjects. Global WASE normal ranges for LV dimensions were smaller than those in the guidelines, but the upper limits of normal for LV volumes and the lower limits of normal for LVEF were higher in the WASE study. Significant intercountry variation was identified for all LV parameters reflecting LV size (dimensions, mass, and volumes) even after indexing to body surface area, with LV end-diastolic and end-systolic volumes having the highest variation. The largest volumes were noted in Australia, while the smallest were measured in India for both genders. This finding suggests that in addition to gender and body surface area, specific country should be considered when evaluating LV volumes. Intercountry variation for LVEF and GLS was smaller but still statistically significant (P < .05 for all)., Conclusions: LV dimensions and volumes are larger in men, while LVEF and GLS are higher in women. Current guideline-recommended normal ranges for LV volumes and LVEF should be adjusted. Intercountry variability is significant for LV volumes, and therefore nationality should be considered for defining ranges of normality., (Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Published
2019
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2. Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study

Author

Federico M. Asch, Tatsuya Miyoshi, Karima Addetia, Rodolfo Citro, Masao Daimon, Sameer Desale, Pedro Gutierrez Fajardo, Ravi R. Kasliwal, James N. Kirkpatrick, Mark J. Monaghan, Denisa Muraru, Kofo O. Ogunyankin, Seung Woo Park, Ricardo E. Ronderos, Anita Sadeghpour, Gregory M. Scalia, Masaaki Takeuchi, Wendy Tsang, Edwin S. Tucay, Ana Clara Tude Rodrigues, Amuthan Vivekanandan, Yun Zhang, Alexandra Blitz, Roberto M. Lang, Aldo D. Prado, Eduardo Filipini, Agatha Kwon, Samantha Hoschke-Edwards, Tania Regina Afonso, Babitha Thampinathan, Maala Sooriyakanthan, Tiangang Zhu, Zhilong Wang, Yingbin Wang, Mei Zhang, Yu Zhang, Lixue Yin, Shuang Li, R. Alagesan, S. Balasubramanian, R.V.A. Ananth, Manish Bansal, Luigi P. Badano, Chiara Palermo, Eduardo Bossone, Davide Di Vece, Michele Bellino, Tomoko Nakao, Takayuki Kawata, Megumi Hirokawa, Naoko Sawada, Yousuke Nabeshima, Hye Rim Yun, Ji-won Hwang, Dolapo Fasawe, Marcus Schreckenberg, Ricardo Ronderos, Gregory Scalia, V. Amuthan, Ravi Kasliwal, Pedro Gutierrez-Fajardo, James Kirkpatrick, Asch, F, Miyoshi, T, Addetia, K, Citro, R, Daimon, M, Desale, S, Fajardo, P, Kasliwal, R, Kirkpatrick, J, Monaghan, M, Muraru, D, Ogunyankin, K, Park, S, Ronderos, R, Sadeghpour, A, Scalia, G, Takeuchi, M, Tsang, W, Tucay, E, Tude Rodrigues, A, Vivekanandan, A, Zhang, Y, Blitz, A, Lang, R, Prado, A, Filipini, E, Kwon, A, Hoschke-Edwards, S, Afonso, T, Thampinathan, B, Sooriyakanthan, M, Zhu, T, Wang, Z, Wang, Y, Zhang, M, Yin, L, Li, S, Alagesan, R, Balasubramanian, S, Ananth, R, Bansal, M, Badano, L, Palermo, C, Bossone, E, Di Vece, D, Bellino, M, Nakao, T, Kawata, T, Hirokawa, M, Sawada, N, Nabeshima, Y, Yun, H, Hwang, J, Fasawe, D, Schreckenberg, M, Amuthan, V, Gutierrez-Fajardo, P, Woo Park, S, Asch, Fm, Fajardo, Pg, Kasliwal, Rr, Kirkpatrick, Jn, Monaghan, Mj, Ogunyankin, Ko, Park, Sw, Ronderos, Re, Scalia, Gm, Rodrigues, Act, Lang, Rm, Prado, Ad, Afonso, Tr, Zhu, Tg, Wang, Zl, Wang, Yb, Yin, Lx, Ananth, Rva, Badano, Lp, Yun, Hr, and Hwang, Jw

Subjects
Adult, Male, medicine.medical_specialty, Longitudinal strain, Multiracial, Heart Ventricles, Normal values, 030204 cardiovascular system & hematology, Ventricular Function, Left, Normal value, 030218 nuclear medicine & medical imaging, Age and gender, 03 medical and health sciences, 0302 clinical medicine, Reference Values, Interquartile range, Internal medicine, Ethnicity, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Prospective Studies, Societies, Medical, Aged, WASE, Body surface area, Ejection fraction, business.industry, Racial Groups, Left ventricular size, Stroke Volume, Organ Size, Middle Aged, Left ventricle, United States, Cross-Sectional Studies, Echocardiography, International, Cardiology, Female, Core laboratory, Cardiology and Cardiovascular Medicine, business
Abstract

Background: The World Alliance Societies of Echocardiography (WASE) Normal Values Study evaluates individuals from multiple countries and races with the aim of describing normative values that could be applied to the global community worldwide and to determine differences and similarities among people from different countries and races. The present report focuses specifically on two-dimensional (2D) left ventricular (LV) dimensions, volumes, and systolic function. Methods: The WASE Normal Values Study is a multicenter international, observational, prospective, cross-sectional study of healthy adult individuals. Participants recruited in each country were evenly distributed among six predetermined subgroups according to age and gender. Comprehensive 2D transthoracic echocardiograms were acquired and analyzed following strict protocols based on recent American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Analysis was performed at the WASE 2D core laboratory and included 2D LV dimensions, LV volumes, and LV ejection fraction (LVEF) by the biplane Simpson method and global longitudinal strain (GLS). Results: Two thousand eight subjects were enrolled in 15 countries. The median age was 45 years (interquartile range, 32–65 years), 42.8% were white, 41.8% were Asian, and 9.7% were black. LV dimensions and volumes were larger in male subjects, while LVEF and GLS were higher in female subjects. Global WASE normal ranges for LV dimensions were smaller than those in the guidelines, but the upper limits of normal for LV volumes and the lower limits of normal for LVEF were higher in the WASE study. Significant intercountry variation was identified for all LV parameters reflecting LV size (dimensions, mass, and volumes) even after indexing to body surface area, with LV end-diastolic and end-systolic volumes having the highest variation. The largest volumes were noted in Australia, while the smallest were measured in India for both genders. This finding suggests that in addition to gender and body surface area, specific country should be considered when evaluating LV volumes. Intercountry variation for LVEF and GLS was smaller but still statistically significant (P < .05 for all). Conclusions: LV dimensions and volumes are larger in men, while LVEF and GLS are higher in women. Current guideline-recommended normal ranges for LV volumes and LVEF should be adjusted. Intercountry variability is significant for LV volumes, and therefore nationality should be considered for defining ranges of normality.

Published
2019

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