Echocardiographic Measurements in Normal Chinese Adults (EMINCA) II focusing on left ventricular and left atrial size and function by three-dimensional echocardiography
1. State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China 2. Department of Cardiology, Qilu Hospital of Shandong University (Qingdao), Qingdao 266000, China 3. Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu 610041, China 4. Department of Ultrasonography, Shenzhen People’s Hospital/The Second Clinical Medical College of Jinan University, Shenzhen 518020, China 5. Department of Ultrasonography, Electronic Science and Technology University of China, The Affiliated Sichuan Provincial People’s Hospital, Chengdu 610072, China 6. Department of Cardiology, Peking University People’s Hospital, Beijing 100044, China 7. Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou 463599, China 8. Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150007, China 9. Department of Echocardiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China 10. Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China 11. Department of Echocardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China 12. Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China 13. Department of Ultrasonography, The Southwest Hospital of AMU, Chongqing 400038, China 14. Department of Ultrasonography, Shengjing Hospital of China Medical University, Shenyang 110136, China 15. Department of Ultrasonography, China-Japan Union hospital of Jilin University, Changchun 130033, China 16. Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China 17. Department of Ultrasonography, The First Affiliated Hospital of Guangxi Medical University, Nanning 537406, China 18. Department of Echocardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050061, China 19. Department of Ultrasonography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China 20. Department of Ultrasonography, The Second Affiliated Hospital of Harbin Medical University, Harbin 150088, China 21. Department of Ultrasonography, Tangdu Hospital of Air Force Medical University of PLA, Xi’an 710038, China 22. Department of Ultrasonography, Wuhan Asia Heart Hospital, Wuhan 430022, China 23. Department of Cardiology, Qingdao Municipal Hospital, Qingdao 266071, China 24. Department of Ultrasonography, Yan’an Hospital Affiliated to Kunming Medical University, Kunming 650051, China 25. Department of Ultrasonography, The People’s Hospital of Liaoning Province, Shenyang 110067, China 26. Department of Ultrasonography, Renmin Hospital of Wuhan University/ Hubei General Hospital, Wuhan 430060, China 27. Department of Ultrasonography, Fuwai Hospital/Chinese Academy of Medical Sciences, Beijing 100037, China 28. Department of Ultrasonography, Jiangsu Province Hospital, Nanjing 210029, China
Current guidelines encourage large studies in a diverse population to establish normal reference ranges for three-dimensional (3D) echocardiography for different ethnic groups. This study was designed to establish the normal values of 3D-left ventricular (LV) and left atrial (LA) volume and function in a nationwide, population-based cohort of healthy Han Chinese adults. A total of 1117 healthy volunteers aged 18–89 years were enrolled from 28 collaborating laboratories in China. Two sets of 3D echocardiographic instruments were used, and full-volume echocardiographic images were recorded and transmitted to a core laboratory for image analysis with a vendor-independent off-line workstation. Finally, 866 volunteers (mean age of 48.4 years, 402 men) were qualified for final analysis. Most parameters exhibited substantial differences between different sex and age groups, even after indexation by body surface area. The normal ranges of 3D-LV and 3D-LA volume and function differed from those recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines, presented by the World Alliance Societies of Echocardiography (WASE) study, and from the 2D values in the EMINCA study. The normal reference values of 3D echocardiography-derived LV and LA volume and function were established for the first time in healthy Han Chinese adults. Normal ranges of 3D-LV and 3D-LA echocardiographic measurements stratified with sex, age, and race should be recommended for clinical applications.
Any other major diseases (cardiovascular diseases, endocrine diseases, respiratory diseases, severe anemia, and connective tissue disease)
Tab.1
Fig.1
Fig.2
Variables
Values (percentage)
Age (year)
48 (18–88)
Age group (year)
18–29
185 (21.3%)
30–39
153(17.7%)
40–49
141 (16.3%)
50–59
139 (16.1%)
60–69
136 (15.7%)
≥ 70
112 (12.9%)
Sex
Men
402 (46.4%)
Women
464 (53.6%)
Height (cm)
165 (146–188)
Weight (kg)
61 (45–91)
BSA (m2)
1.76 (1.48–2.25)
Hear rate (beats/min)
72 (50–90)
SBP (mmHg)
120 (80–145)
DBP (mmHg)
76 (50–90)
Tab.2
Men
Women
Parameters
Total (n = 365)
18−40 (n = 151)
41−65 (n = 148)
> 65 (n = 66)
Total (n = 425)
18−40 (n = 178)
41−65 (n = 173)
> 65 (n = 74)
3D-LVEDV (mL)
87.7 ± 21.6
95.6 ± 20.7
84.9 ± 20.9*
75.2 ± 17.8*&
74.2 ± 16.3#
76.8 ± 16.1#
73.1 ± 15.6#
70.3 ± 17.2
3D-LVEDVI (mL/m2)
49.5 ± 12.5
53.9 ± 12.0
47.5 ± 12.5*
43.8 ± 10.2*
46.8 ± 12.8#
48.1 ± 13.6#
45.9 ± 12.1
45.3 ± 12.1
3D-LVESV (mL)
33.6 ± 10.4
37.6 ± 9.9
31.9 ± 10.1*
28.2 ± 8.8*
27.6 ± 8.2#
28.0 ± 7.9#
27.5 ± 8.0#
26.6 ± 9.0
3D-LVESVI (mL/m2)
19.1 ± 5.9
21.2 ± 5.6
18.0 ± 5.8*
16.4 ± 4.9*
17.7 ± 5.4#
18.1 ± 5.3#
17.6 ± 5.2#
17.1 ± 6.1
3D-LVSV (mL)
54.0 ± 13.3
58.0 ± 13.3
53.0 ± 13.1*
47.0 ± 10.4*&
46.7 ± 9.9#
48.8 ± 10.2#
45.6 ± 9.1*#
43.7 ± 9.9
3D-LVSVI (mL/m2)
30.6 ± 7.6
32.7 ± 7.7
29.8 ± 7.4*
27.4 ± 6.1*&
30.0 ± 6.8
31.4 ± 6.9
29.2 ± 6.2*
28.2 ± 7.2
3D-LVEF (%)
61.9 ± 5.3
60.8 ± 5.3
62.6 ± 5.5*
62.8 ± 4.6*
63.2 ± 5.3#
63.9 ± 5.0#
62.7 ± 5.1
62.7 ± 6.2
3D-LVGLS (%)
−22.2 ± 4.0
−21.9 ± 3.9
−22.3 ± 4.1
−22.4 ± 4.0
−23.0 ± 4.9#
−23.0 ± 5.6#
−22.9 ± 4.0
−23.2 ± 4.8
3D-LVGCS (%)
−30.1 ± 5.2
−29.6 ± 5.0
−30.4 ± 5.4
−30.5 ± 4.8
−30.9 ± 5.3
−30.7 ± 5.4
−30.9 ± 5.1
−30.6 ± 5.9
Tab.3
Fig.3
EMINCA II (mean ± SD)
WASE (mean ± SD)
Guidelines (mean ± SD)
Parameters
Men
Women
P
Men
Women
Men
Women
3D-LVEDVI (mL/m2)
50 ± 13*
47 ± 13*
0.001
70 ± 15
65 ± 12
50 ± 12
46 ± 9
3D-LVESVI (mL/m2)
19 ± 5.9*
18 ± 5.4*
<0.001
28 ± 7
25 ± 6
19 ± 5
17 ± 4
3D-LVEF (%)
62 ± 5.3^
63 ± 5.3
0.005
60 ± 5
62 ± 5
61 ± 4
63 ± 4
3D-LVGLS (%)
−22 ± 4.0*
−23 ± 4.9*
0.022
−21 ± 3
−22 ± 3
NA
NA
3D-LVGCS (%)
−30 ± 5.2
−31 ± 5.3*
0.868
−31 ± 4
−32 ± 4
NA
NA
Tab.4
Fig.4
Men
Women
Parameters
Total (n = 358)
18–40 (n =144)
41–65 (n = 148)
> 65 (n = 66)
Total (n = 425)
18–40 (n = 180)
41–65 (n = 172)
> 65 (n = 73)
3D-LAVmax (mL)
34.5 ± 10.7
32.3 ± 10.2
35.8 ± 9.9*
36.0 ± 12.8*
32.1 ± 10.2#
29.4 ± 9.2#
33.3 ± 10.1*#
35.7 ± 11.1*
3D-LAVmaxI (mL/m2)
19.4 ± 5.9
17.8 ± 5.5
20.2 ± 5.5*
20.9 ± 7.1*
20.7 ± 6.5
19.0 ± 5.9
21.3 ± 6.4*
23.2 ± 7.1*&#
3D-LAVmin (mL)
13.9 ± 4.5
12.9 ± 4.3
14.6 ± 4.3*
14.4 ± 5.2*
12.7 ± 4.4#
11.2 ± 3.5#
13.6 ± 4.5*#
14.4 ± 4.7*
3D-LAVminI (mL/m2)
7.8 ± 2.5
7.1 ± 2.3
8.2 ± 2.3*
8.4 ± 2.9*
8.2 ± 2.8
7.2 ± 2.3
8.7 ± 2.9*
9.4 ± 3.0*
3D-LAEV (mL)
20.6 ± 7.1
19.5 ± 6.9
21.2 ± 6.6*
21.5 ± 8.4*
19.5 ± 7.0#
18.4 ± 7.0
19.8 ± 6.7*#
21.3 ± 7.2*
3D-LAEVI (mL/m2)
11.6 ± 4.0
10.7 ± 3.7
12.0 ± 3.7
12.5 ± 4.7
12.5 ± 4.4#
11.8 ± 4.4
12.6 ± 4.2
13.9 ± 4.6*
3D-LAEF (%)
57.3 ± 5.7
58.8 ± 5.5
56.7 ± 6.2
56.4 ± 5.0
57.5 ± 6.4
58.9 ± 6.1
57.6 ± 5.9
55.8 ± 7.3*
Tab.5
EMINCA II (mean ± SD)
WASE (mean ± SD)
Men
Women
Men
Women
Parameters
18–40 y
41–65 y
> 65 y
18–40 y
41–65 y
> 65 y
18–40 y
41–65 y
> 65 y
18–40 y
41–65 y
> 65 y
3D-LAVmax (mL)
32 ± 10*
36 ± 10*
36 ± 13*
29 ± 9*
33 ± 10*
36 ± 11*
51 ± 14
55 ± 16
56 ± 15
44 ± 11
47 ± 12
49 ± 13
3D-LAVmaxI (mL/m2)
18 ± 6*
20 ± 6*
21 ± 7*
19 ± 6*
21 ± 6*
23 ± 7*
27 ± 6
29 ± 8
31 ± 8
27 ± 6
28 ± 7
30 ± 7
3D-LAVmin (mL)
13 ± 4*
15 ± 4*
14 ± 5*
11 ± 4*
14 ± 5*
14 ± 5*
19 ± 7
21 ± 8
22 ± 8
16 ± 5
18 ± 6
20 ± 7
3D-LAVminI (mL/m2)
7.1 ± 2*
8 ± 2*
8.4 ± 32.9*
7.2 ± 2*
8.7 ± 3*
9.4 ± 3*
10 ± 3
11 ± 4
12 ± 4
10 ± 3
11 ± 4
12 ± 4
3D-LAEV (mL)
20 ± 7*
21 ± 7*
22 ± 8*
18 ± 7*
20 ± 7*
21 ± 7*
30 ± 10
36 ± 12
39 ± 12
25 ± 7
30 ± 9
34 ± 10
3D-LAEVI (ml/m2)
11 ± 4*
12 ± 4*
13 ± 5*
11 ± 4*
13 ± 4*
14 ± 5*
16 ± 4
19 ± 6
21 ± 6
15 ± 4
18 ± 5
21 ± 6
3D-LAEF (%)
59 ± 6*
57 ± 6
56 ± 5*
59 ± 6*
58 ± 6*
56 ± 7
63 ± 8
62 ± 7
60 ± 8
65 ± 7
62 ± 8
60 ± 7
Tab.6
Fig.5
Fig.6
Men (LNL to UNL)
Women (LNL to UNL)
Parameters
Total men
18–40 y
41–65 y
> 65 y
Total women
18–40 y
41–65 y
> 65 y
3D-LVEDV (mL)
50.4–138.0
59.3–144.7
49.6–132.7
43.3–133.1
43.1–108.2
47.8–107.4
42.1–108.8
42.2–109.4
3D-LVEDVI (mL/m2)
27.6–76.0
33.5–76.6
21.6–74.2
19.7–73.9
29.2–70.2
30.0–73.0
29.3–68.2
24.5–66.1
3D-LVESV (mL)
17.7–56.3
21.6–58.1
16.6–55.5
17.1–58.8
14.5–46.8
17.4–46.4
13.8–45.2
12.4–48.8
3D-LVESVI (mL/m2)
10.0–32.0
12.0–32.7
8.8–32.0
6.7–32.4
9.1–29.5
9.1–31.0
8.3–29.0
8.0–29.1
3D-LVSV (mL)
32.2–82.7
35.9–89.1
31.8–81.4
26.9–79.3
26.1–68.9
28.8–70.5
25.5–67.7
25.4–63.9
3D-LVSVI (ml/m2)
17.8–48.1
20.1–49.6
16.3–46.7
17.6–44.5
17.5–45.0
16.3–47.0
17.2–42.2
13.5–41.1
3D-LVEF (%)
51.5–72.3
51.1–70.6
50.0–72.7
49.8–71.9
52.8–73.6
53.3–73.3
52.3–72.4
49.7–77.0
3D-LVGLS (%)
−15.4 to −29.7
−15.6 to −30.4
−14.4 to −30.0
−14.6 to −30.0
−15.7 to −32.7
−16.1 to −33.0
−15.7 to −31.6
−15.2 to −33.8
3D-LVGCS (%)
−20.5 to −40.9
−20.9 to −39.3
−20.0 to −41.9
−19.3 to −41.1
−20.5 to −41.3
−19.9 to −41.0
−19.7 to −41.6
−20.5 to −45.5
3D-LAVmax (mL)
16.1–57.0
16–57
19–54
17–70
15–56
16–53
17–56
15–61
3D-LAVmaxI (mL/m2)
10–32
9–31
11–31
10–40
10–36
10–36
11–35
10–39
3D-LAVmin (mL)
7–26
7–25
8–25
7–31
6–23
6–20
7–23
7–25
3D-LAVminI (mL/m2)
4–14
4–13
4–13
4–17
4–15
4–13
5–16
4–16
3D-LAEV (mL)
9–37
9–36
10–36
10–40
9–35
8–35
9–34
9–38
3D-LAEVI (mL/m2)
5–21
5–18
6–21
5–23
6–23
5–23
6–21
6 –24
3D-LAEF (%)
46–70
45–71
46–70
45–65
44–69
44–69
43–67
44–63
Tab.7
Fig.7
EMINCA II
EMINCA
Parameters
Men
Women
P
Men (n = 678)
Women (n = 716)
P
3D-LVEDV (mL)
87.7 ± 21.6
74.2 ± 16.3
< 0.001
2D-LVEDV (mL)
86.7 ± 20.8
72.2 ± 17.6
< 0.001
3D-LVESV (mL)
33.6 ± 10.4*
27.6 ± 8.2*
< 0.001
2D-LVESV (mL)
31.2 ± 9.6
26.0 ± 9.0
< 0.001
3D-LVEF (%)
61.9 ± 5.3*
63.2 ± 5.3*
0.005
2D-LVEF (%)
64.4 ± 6.0
65.0 ± 6.2
0.34
3D-LAVmax (mL)
34.5 ± 10.7*
32.1 ± 10.2*
0.002
2D-LAV (mL)
38.0 ± 11.6
34.8 ± 10.7
< 0.001
Tab.8
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