Abstract
BackgroundCardiovascular magnetic resonance (CMR) reference ranges have not been well established in Chinese. Here we determined normal cardiac and aortic reference ranges in healthy Singaporean Chinese and investigated how these data might affect clinical interpretation of CMR scans.MethodsIn 180 healthy Singaporean Chinese (20 to 69 years old; males, n = 91), comprehensive cardiac assessment was performed using the steady state free precision technique (3T Ingenia, Philips) and images were analysed by two independent observers (CMR42, Circle Cardiovascular Imaging). Measurements were internally validated using standardized approaches: left ventricular mass (LVM) was measured in diastole and systole (with and without papillary muscles) and stroke volumes were compared in both ventricles. All reference ranges were stratified by sex and age; and “indeterminate/borderline” regions were defined statistically at the limits of the normal reference ranges. Results were compared with clinical measurements reported in the same individuals.ResultsLVM was equivalent in both phases (mean difference 3.0 ± 2.5 g; P = 0.22) and stroke volumes were not significantly different in the left and right ventricles (P = 0.91). Compared to females, males had larger left and right ventricular volumes (P < 0.001 for all). Indexed LVM was significantly higher in males compared to females (50 ± 7 versus 38 ± 5 g/m2, respectively; P < 0.001). Overall, papillary muscles accounted for only ~2 % of the total LVM. Indexed atrial sizes and aortic root dimensions were similar between males and females (P > 0.05 for all measures). In both sexes, age correlated negatively with left and right ventricular volumes; and positively with aortic sinus and sinotubular junction diameters (P < 0.0001 for all). There was excellent agreement in indexed stroke volumes in the left and right ventricles (0.1±5.7mL/m2, 0.7±6.2 mL/m2, respectively), LVM (0.6±6.4g/m2), atrial sizes and aortic root dimensions between values reported in clinical reports and our measured reference ranges.ConclusionsComprehensive sex and age-corrected CMR reference ranges at 3T have been established in Singaporean Chinese. This is an important step for clinical practice and research studies of the heart and aorta in Asia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-016-0236-3) contains supplementary material, which is available to authorized users.
Highlights
Cardiovascular magnetic resonance (CMR) reference ranges have not been well established in Chinese
A vast majority of CMR reference ranges have been established in healthy individuals from the West [7,8,9,10] and they may not be representative of the diverse world population to which these values are applied in
Left ventricular dimensions and function according to sex and age Absolute and indexed left ventricular (LV) excellent inter-operator reproducibility in the LV (EDV) and End systolic volume (ESV) were larger in males compared to females (P < 0.0001 for all)
Summary
Cardiovascular magnetic resonance (CMR) reference ranges have not been well established in Chinese. We determined normal cardiac and aortic reference ranges in healthy Singaporean Chinese and investigated how these data might affect clinical interpretation of CMR scans. There are no studies examining CMR reference ranges for atrial sizes and aortic root dimensions in Asia despite their important prognostic implications [11,12,13]. As the indications of CMR continues to expand in Asia [2], there remains an urgent need to establish reference ranges in order to confidently differentiate abnormal from normal phenotypes. We set out to define comprehensive age and sex specific reference ranges for left and right ventricular and atrial dimensions, left ventricular mass (LVM) and aortic root dimensions in healthy Singaporean Chinese. In the same cohort of healthy individuals, we compared our reference ranges with clinically derived measurements and examined the potential impact of adopting our newly derived ranges in the local setting
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