Echocardiographic Reference Values Research Articles

Racial Differences in Age-Related Changes in Left Ventricular Structural and Functional Echocardiographic Measurements Among Healthy Japanese and American Participants - A Subanalysis of the World Alliance Society of Echocardiography Normal Values Study.

Age-related changes in left ventricular (LV) structure and function lower the threshold for the onset of heart failure with preserved ejection fraction (HFpEF). LV parameters change also with race; however, the racial differences in age-related changes in LV parameters with and without adjustment for body mass index (BMI), heart rate (HR), and blood pressure (BP) remain unclear. We performed a subanalysis of the World Alliance Society of Echocardiography Normal Values Study, an international cross-sectional study that examined normal echocardiographic values in 15 countries. The age-related changes in 2-dimensional echocardiographic derived parameters including LV size, systolic function, and mass, were compared between healthy Japanese (n=227) and healthy White (n=98) and Black (n=69) American participants. In men, age-related changes in all parameters did not differ significantly among races. However, compared with Japanese women, White American women had a smaller body surface area (BSA)-indexed LV volume, BSA-indexed LV internal dimension at end-systole, BSA-indexed LV stroke volume, and LV mass index to BSA, and a larger LV ejection fraction with age, even after adjusting for BMI, HR, and BP. Age-related changes in LV structure and function, which are important for the pathophysiology of HFpEF, may differ by race. Therefore, future studies examining echocardiographic reference values for each age group in each race are needed.

Right parasternal echocardiographic reference values in the healthy male Iranian Shall sheep.

Among the large animals, the heart of sheep is functionally and structurally very similar to the human heart. In research, sheep are used as an animal model to study the process of cardiac disease pathogenesis and treatment. Therefore, determining the normal values of the heart structures of sheep with echocardiography is of particular emphasis. The purpose of the present research is to define the normal echocardiography values of heart in Iranian Shall breed sheep. In 20 healthy Iranian Shall male sheep weighing 30-35kg and aged 4-6 months, standing echocardiography was done from the right parasternal approach concentrated on the 3rd to 5th intercostal spaces by 2.5-5MHz phased array transducer in the longitudinal and transverse views by B-mode, M-mode and Doppler systems. In M-mode echocardiographic, the parameters of interventricular septal, left ventricular internal diameter, left ventricular free wall, right ventricular free wall and right ventricular internal diameter in diastole and systole as well as end point septal separation, ejection fraction (EF) slope, aortic root diameter, left atrial appendage, left atrial diameter/aortic valve diameter, left ventricular ejection time, fractional shortening, end-diastolic volume, end-systolic volume, EF, stroke volume and cardiac output and in pulsed-wave spectral Doppler echocardiographic, the parameters of mitral valve maximum velocity (Vmax), mitral valve mean velocity (Vmean), mitral valve maximum pressure gradient (PGmax), mitral valve mean pressure gradient (PGmean), mitral valve velocity time integral (VTI), mitral valve E-wave (MV-E), MV-E pressure gradient, mitral valve A-wave (MV-A), MV-A pressure gradient, aortic Vmax, aortic valve Vmean, aortic valve PGmax, aortic valve PGmean, aortic valve VTI, left ventricular outflow tract (LVOT)-Vmax, LVOT-Vmean were measured. All the sheep in this study were healthy and had no signs of heart disease. In this study, the parameters of M-mode and spectral Doppler echocardiographic were assessed and recognized in Iranian Shall sheep. The results demonstrated the parameters of echocardiographic could be dependably determined in Shall sheep which, established normal reference values for these parameters and left ventricular function indices in healthy Shall sheep. These results can be beneficial in appropriate imagination, recognition and measuring cardiac structures. This study can be exerted as a reference for the assessment and diagnosis of heart diseases in sheep medicine and human cardiovascular research in sheep experimental models.

Fetal 4D flow MRI of the great thoracic vessels at 3 Tesla using Doppler-ultrasound gating: a feasibility study

ObjectivesTo evaluate the feasibility of Doppler-ultrasound (DUS)-gated 4D flow MRI of the fetal great thoracic vessels at 3T in a clinical setting.MethodsSixteen consecutive fetuses (range 30+4–38+5 weeks) with (n = 11) and without (n = 5) cardiovascular anomalies underwent 4D flow MRI of the great thoracic vessels at 3T. Direct fetal cardiac gating was obtained using a MR-compatible DUS device. 4D flow MRI–based visualisation and quantification of four target regions (ascending aorta (AAo), descending aorta (DAo), main pulmonary artery (MPA), and ductus arteriosus (DA)) were performed using dedicated software.ResultsFetal 4D flow MRI of the great thoracic vessels was successful in 12/16 fetuses (75%) by adopting clinical 4D flow MR protocols in combination with direct fetal cardiac DUS-gating. Four datasets were excluded due to artefacts by fetal movement or maternal breathing. 4D flow MRI–derived time-velocity curves revealed typical arterial blood flow patterns in the aorta. 4D flow quantification was achieved for the pre-defined target regions. Average velocity and flow volume were 21.1 ± 5.2 cm/s and 6.0 ± 3.1 mL/s in the AAo, 24.3 ± 6.7 cm/s and 8.4 ± 3.7 mL/s in the DAo, 21.9 ± 6.4 cm/s and 7.8 ± 4.2 mL/s in the MPA, and 23.4 ± 4.7 cm/s and 5.9 ± 3.6 mL/s in the DA, respectively.ConclusionsCombination of DUS-gating of the fetal heart and 4D flow MRI allows comprehensive visualisation and quantification of haemodynamics in the fetal great thoracic vessels. DUS-gated fetal 4D flow MRI may provide a new diagnostic approach for prenatal assessment of blood flow haemodynamics.Key Points• Fetal cardiac Doppler-ultrasound (DUS) gating and 4D flow MRI can be successfully combined.• DUS-gated fetal 4D flow MRI allowed visualisation and evaluation of streamline directionality, illustration of blood flow variations, and pulsatile arterial waveforms in the target vessels.• 4D flow MRI–based visualisation and quantification of the fetal great thoracic vessels were successful and flow metrics agreed with echocardiographic reference values.

Cardiac remodelling in adolescent athletes – sex differences progress through adolescence

Abstract Background Cardiac remodelling beyond reference values is well-known in adult athlete's heart. Male endurance athletes are more prone to develop cardiac chambers and wall thickness above reference values. Cardiac remodelling is also described in adolescent athletes, but considered to be moderate compared to adults. However, few studies evaluate adolescent athlete's heart by paediatric echocardiographic reference values. Current paediatric reference values are sex-unspecific and do not include exercise data. The impact of sex and exercise on remodelling in adolescent athlete's heart remains unclear. Purpose We aimed to study the development of cardiac remodelling and potential sex differences in adolescent athletes. We hypothesized that male adolescent athletes would display greater degree of remodelling compared to female adolescent athletes. Methods Male (M) and female (F) adolescent cross-country skiers were recruited in a longitudinal cohort study. They were examined with echocardiography at age 12, 15 and 18. Data on exercise was collected at all examinations. We evaluated echocardiographic parameters by paediatric reference values (Z-score: number of standard deviations above estimated mean in the given body surface area). Echocardiographic measures were considered above upper reference value if Z-score was ≥2. Results Seventy-six athletes were examined at age 12 (48 M, 28 F), 48 at age 15 (34 M, 14 F) and 34 at age 18 (23 M, 11 F). Although Z-scores were within reference values at age 12 (Table 1), a subset of athletes displayed Z-scores ≥2 for end-diastolic intraventricular septum diameter (IVSd, M 13/48=27%, F 5/28=18%) and left ventricular posterior wall thickness (LVPWd, M 6/48=13%, F 2/28=14%). The male group demonstrated enlarged left ventricular mass (LVM) from age 15 (Figure 1). Males had greater left ventricular end-diastolic volume (LV EDV) from age 12. Additional sex differences were evident from age 15 for IVSd, LVPWd and LVM (Table 1). There was no sex difference in exercise hours. Both groups had normal myocardial function through the study period. Conclusion Cardiac remodelling beyond reference values was observed in athletes of both sexes from early adolescent age. Sex differences were evident from age 12 with further progression. Pathological values for LVM were more frequent in males. These findings suggest that sex differences in exercise-induced cardiac remodelling is more prominent in adolescents than previously reported. Sex and exercise history should be considered in questions of pathology. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The South-Eastern Norway Regional Health AuthorityCentre for Children and Youth Sport, Norwegian School of Sport Sciences

New Echocardiography Reference Ranges for Aotearoa (NewERA) Study: the application of international echocardiographic reference values to linear measurements of the hearts of healthy, young Māori and Pacific adults may not detect cardiac enlargement.

To develop ethnic-specific echocardiography reference ranges for Aotearoa, and to investigate the impact of indexation to body surface area (BSA). Current reference international ranges are derived from people of mostly NZ European ethnicity and may not be appropriate for Māori and New Zealanders of Pacific ethnicity, who both experience high rates of cardiovascular disease. Echocardiography was performed in a cross-sectional study of 263 healthy adults (18-50 years): Māori (N=71, 43 female), Pacific (N=53, 28 female), European (N=139, 74 female). Linear measurements of the left heart are reported and indexed to BSA. The upper/lower limit of normal (ULN/LLN) by ethnicity and sex were derived (quantile regression). Ethnic- and sex-specific differences were examined using ANOVA. The ULN was higher for all un-indexed dimensions in men compared to women, and for most indices the ULN was smallest in NZ Europeans and largest in Māori and Pacific peoples. Indexation reversed these relationships: NZ Europeans had higher ULN for many measurements. Indexing to BSA introduced bias that preferences the NZ European ethnicity by creating an upper limit reference threshold that far exceeds this sample's upper range. As a result, this may lead to under-recognition of cardiac enlargement in Māori and Pacific patients, and in particular for women. Unique reference ranges for all ethnic groups and sexes are required to optimally detect and manage cardiovascular diseases (CVD) in Aotearoa.

Normal Echocardiographic Reference Values of the Right Ventricular to Left Ventricular Endsystolic Diameter Ratio and the Left Ventricular Endsystolic Eccentricity Index in Healthy Children and in Children With Pulmonary Hypertension.

BackgroundAn accurate assessment of the right and left ventricle and their interaction is important in pediatric pulmonary hypertension (PH). Our objective was to provide normal reference values for the right ventricular to left ventricular endsystolic (RV/LVes) ratio and the LV endsystolic eccentricity index (LVes EI) in healthy children and in children with PH.MethodsWe conducted an echocardiographic study in 769 healthy children (median age: 3.36 years; range: 1 day—18 years) and validated abnormal values in 44 children with PH (median age: 2.1 years; range: 0.1 months—17.7 years). We determined the effects of gender, age, body length, body weight, and body surface area (BSA) on RV/LVes ratio and LVes EI values. The RV/LVes ratio and LVes EI were measured from the parasternal short axis view between papillary muscle from the endocardial to endocardial surfaces.ResultsBoth, the RV/LVes ratio and the LVes EI were highly age-dependent: (i) neonates RV/LVes ratio [median 0.83 (range 0.53–1.37)], LVes EI [1.21 (0.92–1.45)]; (ii) 12–24 months old: RV/LVes ratio: [0.55 (0.35–0.80)], LVes EI: [1.0 (0.88–1.13)]; iii) 18th year of life RV/LVes ratio: [0.53 (0.32–0.74)], LVes EI: [1.0 (0.97–1.07)]. Healthy neonates had high LVes EI and RV/LVes ratios, both gradually decreased within the first year of life and until BSA values of about 0.5 m2, body weight to about 15 kg and body length to about 75 cm, but were almost constant thereafter. Children (>1 year) and adolescents with PH had significantly higher RV/LVes ratio (no PH: median 0.55, IQR 0.49–0.60; PH: 1.02, 0.87–1.26; p < 0.001) and higher LVes EI values (no PH: 1.00, 0.98–1.00; PH: 1.53, 1.26–1.71; p < 0.001) compared to those without PH. To predict the presence of PH in children > 1 year, we found the following best cutoff values: RV/LVes ratio ≥ 0.67 (sensitivity: 1.00, specificity: 0.95) and LVes EI ≥ 1.06 (sensitivity: 1.00, specificity: 0.97).ConclusionWe provide normal echocardiographic reference values of the RV/LVes ratio and LVes EI in healthy children, as well as statistically determined cutoffs for the increased values in children with PH.

Global longitudinal strain and echocardiographic parameters of left ventricular geometry and systolic function in healthy adult Angolans: Effect of age and gender.

Studies on the normal echocardiographic reference values in Africans are limited. This study aims to establish the normal left ventricular echocardiographic parameters for adult Angolans, stratified by gender and age. A cross-sectional study was performed involving healthy adults attending a diagnostic center in Luanda, Angola. The two-dimensional transthoracic echocardiography was performed according to the Guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. A total of 103 men (47.5%) (mean age: 39.5±10,8) and 114 women (52.5%) (mean age: 43.0±12,5 years) were included. Compared to men, women were older (p=0.025) and had a significantly smaller body surface area (BSA) (p<0.001). Left ventricular wall thickness, left ventricular end-diastolic dimension and volume (LVEDV), left ventricular mass (LVM) and LVM indexed to BSA (LVMi) were significantly lower in women (p<0.005). LVEDD indexed to BSA and left ventricular ejection fraction (LVEF) were significantly higher in women than in men (p=0.007), (p=0.01), respectively. Mitral annular plane systolic excursion, LVEF by strain, and global longitudinal strain showed no gender differences. Posterior wall thickness showed a statistically significant increase in the older groups (p=0.043). The VST, relative wall thickness, LVM, and LVMi showed no significant differences between age categories. In turn, the shortening fraction and the ejection fraction increase with age. For a more sensitive morphological and functional assessment of the left ventricle, it is necessary to take into account the gender and age of the individual.

Normal echocardiographic and radiographic reference values for crab-eating fox (Cerdocyon thous) anesthetized with ketamine and midazolam.

The cardiac evaluation of wild animals is still a wide and largely unknown field for several species. Therefore, through complimentary examinations such as radiography, echocardiography and serum troponin levels, this study aimed at describing the values observed in 12 crab-eating foxes (Cerdocyon thous) anesthetized with a combination of intramuscular ketamine and midazolam. Thus, through complementary exams such as radiography, echocardiography and serum troponin levels, the aim of this study was to describe the cardiac values in 12 wild foxes (C. thous) anesthetized with an intramuscular injection of ketamine and midazolam. After anaesthetization, the radiographic, echocardiographic and immunoenzymatic reference values for the 12 males in the sample group were determined. Compared with those in domestic canids, there was a decrease in the sizes of the septum, wall and left ventricular cavity as well as decreases in the transmitral blood flow velocity indices, correlated with preserved serum cardiac troponin (cTnI) levels. Thus, M-mode echocardiography proved to be safer, with results that were comparative to those for other species of wild canids with indexed values. In addition, when evaluating the systolic function and segmentary contractions, the anesthetic combination did not have any effects on the results of complementary examinations performed in crab-eating foxes (C. thous) included in this study.

Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data.

To investigate differences in the prevalence of left ventricular (LV) and left atrial (LA) remodelling in hypertensive patients using various thresholds defined by international guidelines and data from the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and different indexation methods. LV mass (LVM), relative ventricular wall thickness, and LA volume (LAV) were measured using 2D echocardiography in 612 healthy volunteers selected from the EMINCA study population and 306 adult Chinese patients with hypertension who were age- and gender-matched using propensity score-matched analysis. LVM and LAV values were indexed to body surface area (BSA), height2.7, height1.7, and height2 recommended by guidelines or investigators. Using a previously reported method, LV geometry was divided into normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. The prevalence of LV hypertrophy (LVH) and LV geometric patterns in hypertensive patients were compared using different thresholds and indexation methods. Echocardiographic thresholds from guidelines and healthy volunteers exhibited notable differences, particularly for LAV indexed to height2 and for LVM indexed to height1.7, which resulted in a significantly lower prevalence of LA dilatation and LVH in healthy volunteers. The total proportion of abnormal LV geometric patterns was significantly lower with thresholds from healthy volunteers than from guidelines when LVM was indexed to BSA, height1.7, and height2,7. Using current echocardiographic thresholds and indexing methods recommended by guidelines may lead to significant misdiagnosis of LA dilatation, and abnormal LV geometry in Chinese patients with hypertension, and thresholds based on ethnic-specific normal echocardiographic reference values and an accurate indexing algorithm are warranted.

Defining echocardiographic reference values of LV volume indices and biventricular strain in obese patients with normal ejection fraction in different cardiac remodeling patterns – a single center study

Abstract Background The left ventricle (LV) in obese patients undergoes different patterns of remodeling in order to normalize wall stress. However, little is known about how LV volume indices, LV global longitudinal strain and right ventricular free wall strain (GLS) vary according to the pattern of LV remodeling. Aim To define the echocardiographic reference values of LV volumes and biventricular GLS across the different LV remodeling patterns in obese patients with a preserved ejection fraction. Methods 2393 adult obese patients (1428 females, 965 males) with a normal ejection fraction who underwent echocardiography from January 2008 to December 2018 were selected. They were categorized according to 4 cardiac remodeling groups defined by LV mass index (102g/m2 in males, 88g/m2 in females) and relative ventricular wall thickness (0.42): normal geometry (NG), eccentric hypertrophy (EH), concentric remodeling (CR) and concentric hypertrophy (CH). Obese subjects were further categorized by BMI class (30–35, 35–40, &amp;gt;40 kg/m2). Obese subjects were gender matched to controls with a normal BMI (18.5–25 kg/m2) and normal cardiac geometry. Mean ± SD, One-way Anova and Tukey- Kramer HSD were applied. P&amp;lt;0.05 is considered significant. Results The mean age of controls and obese patients' were 50±16 and 57±13.6 years respectively (P&amp;lt;0.0001). LV GLS for controls compared to obese subjects with NG, EH, CR and CH was −21.1±2 vs. −20.2±1.9, −19.6±2.8, −18.5±2.9, −17.5±3.4 respectively (p&amp;lt;0.0001 for all), and for RV GLS it was −27.9±4 vs −26.7±3.9, −25.1±5, −23.5±5.5, −24.1±5.2 respectively (p&amp;lt;0.01 for all, except for NG where p=0.2). The distribution of LV indices according to cardiac remodeling subtypes is shown in the figure. Indexed end diastolic and end systolic volumes were smaller in NG, CH and CR compared to controls (p&amp;lt;0.001 for each respectively). LV GLS and ejection fraction were higher in females, while indexed LV volumes were higher in males within each remodeling category (P&amp;lt;0.0001). No significant difference in LV GLS or indexed LV volume was seen across BMI categories within each remodeling pattern (P&amp;gt;0.05). Obese subjects with CH had the highest incidence of the cardiovascular risk factors hyperlipidemia, hypertension and history of myocardial infarction or stroke, compared to those with other remodeling patterns (p&amp;lt;0.0001 for each, vs. NG, EH and CR). Conclusion To our knowledge, this is the largest study to define LV volumes and left and right ventricular GLS according to LV remodeling pattern and BMI category. The Lowest GLS was noted in CH. Ejection fraction was similar across the LV remodeling patterns. There were no differences in GLS and LV indexed volumes across BMI categories within each remodeling group. These results can be applied as a reference values for the obese population with a normal LV ejection fraction. Funding Acknowledgement Type of funding source: None

A novel parametric method-based nomogram of left ventricular internal diameters in normal Chinese adults.

BackgroundCurrent echocardiographic normal reference values and nomograms in healthy adults are commonly normalized by body surface area (BSA) with simple linear or isometric corrections. However, various lines of evidence suggest this method might be flawed. In this study, we established the normative data of left ventricular internal diameter (LViD) by BSA-correlated regression equations with the calculation of Z-scores in healthy Han Chinese adults.MethodsA total of 577 healthy Han Chinese adults were enrolled (age 44.4±13.0 years, 43% male and 57% female). LViD was acquired from two-dimensional-guided M-mode echocardiography on all participants from the parasternal long-axis view. Linear and nonlinear regression models were built to correlate LViD with BSA in different sexes and age groups. The best-fit models and nomograms are presented with the Z-scores calculated by the models. Residual analysis and reproducibility were evaluated in each best-fit model for reliability.ResultsBody surface area showed polynomial (quadric) correlations with left ventricular end-diastolic diameter (LVDd, R2=0.615, P<0.001) and left ventricular end-systolic diameter (LVDs, R2=0.540, P<0.001). Corresponding regression equations and nomograms for computing the Z-scores of the overall LViD and BSA/sex-specific and BSA/age-specific reference values are presented. Reproducibility, residual distribution, autocorrelation and heteroscedasticity were confirmed in each model.ConclusionsThis study proposes a comprehensive approach for normal reference values of left ventricular internal diameters with echocardiographic nomograms in healthy Han Chinese adults, which may offer a more precise way to diagnose cardiovascular disease in clinical practice.

Reference ranges and Z-scores for fetal cardiac measurements from two-dimensional echocardiography in Asian population

Currently available fetal echocardiographic reference values are derived mainly from North American and European population studies, and there is a lack of reference z-score for fetal echocardiographic measurement in Asian populations. The aim of this study was to establish normal ranges of echocardiographic measurements and z-scores in healthy Asian fetuses. A total of 575 healthy pregnant Taiwanese with an estimated gestational age from 14 to 38 weeks were enrolled voluntarily for this observational study. Standard two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries of the developing fetuses. In contrast to past studies, our sample was more evenly distributed for estimated gestational age (p<0.001). We present percentile graphs for 13 fetal echocardiographic measurements from the knowledge of estimated gestational age, biparietal distance, head circumference, abdominal circumference, and femur length. Most cardiac structures and developmental markers had linear models as the best-fitting, except for transverse aortic isthmus by estimated gestational age and transverse ductus arteriosus by femur length. Our findings indicate that estimated gestational age was generally the best model for fetal heart development, while head circumferences could be used as an optimal developmental marker to predict left atrium, right atrium, right ventricle, pulmonary annulus, and ductus arteriosus. Lastly, we developed nomograms for each of the 13 fetal heart measurements by each developmental markers. This is the first study providing echocardiographic reference ranges and nomograms for Asian fetuses. Computing z-scores from nomograms helps in standardizing comparisons and adds additional prognostic information to the diagnosis of congenital heart disease.

The fallacy of indexed effective orifice area charts to predict prosthesis-patient mismatch after prosthesis implantation.

Aims Indexed effective orifice area (EOAi) charts are used to determine the likelihood of prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR). The aim of this study is to validate whether these EOAi charts, based on echocardiographic normal reference values, can accurately predict PPM.Methods and results In the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial, 986 patients with aortic valve stenosis/regurgitation underwent AVR with an Avalus valve. Patients were randomly split (50:50) into training and test sets. The mean measured EOAs for each valve size from the training set were used to create an Avalus EOAi chart. This chart was subsequently used to predict PPM in the test set and measures of diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) were assessed. PPM was defined by an EOAi ≤0.85 cm2/m2, and severe PPM was defined as EOAi ≤0.65 cm2/m2. The reference values obtained from the training set ranged from 1.27 cm2 for size 19 mm up to 1.81 cm2 for size 27 mm. The test set had an incidence of 66% of PPM and 24% of severe PPM. The EOAi chart inaccurately predicted PPM in 30% of patients and severe PPM in 22% of patients. For the prediction of PPM, the sensitivity was 87% and the specificity 37%. For the prediction of severe PPM, the sensitivity was 13% and the specificity 98%.Conclusion The use of echocardiographic normal reference values for EOAi charts to predict PPM is unreliable due to the large proportion of misclassifications.

Reference values (Z-score) of inlet and trabecular portion diameters of the right ventricle: First description in Spanish healthy children

Right ventricle (RV) measurements are crucial for certain congenital heart diseases and various cardiovascular conditions. Echocardiographic RV diameters are especially useful for its assessment. Paediatric echocardiographic data standardisation in normal subjects is complex, scarce, and heterogeneous. The aim of this study was to establish reliable and reproducible echocardiographic reference values (Z-score) of RV diameters in a healthy Spanish paediatric cohort. A multicentre study was conducted on 661 healthy subjects (age range 0-18 years, 43.5% female). Several regression models were tested to examine the relationship between RV diameters and biometric variables. Heteroscedasticity and residual associations (Shapiro-Wilk and Breusch-Pagan tests) and confounding factors (gender, age, inter/intraobserver agreement) were considered for an unbiased standardisation. Structured Z-scores were computed for each RV diameter. Predicted mean value for each diameter was determined according to age, weight, height, and different body surface area. The Haycock formula provided the best fit for basal, midcavity, and longitudinal diameters (R2 0.81; 0.82; 0.9). Confounders were not significant, and therefore not included in final models (inter/intraobserver agreement > 0.9). This study reports reference values for echocardiographic RV diameters from a Spanish healthy paediatric cohort using a rigorous statistical design. These Z-scores partly cover a gap in current paediatric cardiology and represent a relevant diagnostic tool for clinical practice, as well as a useful guide to decision making at any paediatric stage.

Reference values (Z-score) of inlet and trabecular portion diameters of the right ventricle: First description in Spanish healthy children

Introduction and objectivesRight ventricle (RV) measurements are crucial for certain congenital heart diseases and various cardiovascular conditions. Echocardiographic RV diameters are especially useful for its assessment. Paediatric echocardiographic data standardisation in normal subjects is complex, scarce, and heterogeneous. The aim of this study was to establish reliable and reproducible echocardiographic reference values (Z-score) of RV diameters in a healthy Spanish paediatric cohort. MethodsA multicentre study was conducted on 661 healthy subjects (age range 0–18 years, 43.5% female). Several regression models were tested to examine the relationship between RV diameters and biometric variables. Heteroscedasticity and residual associations (Shapiro–Wilk and Breusch–Pagan tests) and confounding factors (gender, age, inter/intraobserver agreement) were considered for an unbiased standardisation. ResultsStructured Z-scores were computed for each RV diameter. Predicted mean value for each diameter was determined according to age, weight, height, and different body surface area. The Haycock formula provided the best fit for basal, midcavity, and longitudinal diameters (R2 0.81, 0.82, 0.9). Confounders were not significant, and therefore not included in final models (inter/intraobserver agreement > 0.9). ConclusionsThis study reports reference values for echocardiographic RV diameters from a Spanish healthy paediatric cohort using a rigorous statistical design. These Z-scores partly cover a gap in current paediatric cardiology and represent a relevant diagnostic tool for clinical practice, as well as a useful guide to decision making at any paediatric stage.

Pulsed-wave doppler echocardiographic cardiac dimensions of Muzaffarnagari sheep

With the aim to determine reference pulsed-wave Doppler echocardiographic cardiac dimensions in sheep, transthoracic echocardiographic examination in right lateral position was performed in 20 healthy adult female Muzaffarnagari sheep. The study was conducted between August, 2014 and March, 2015 at ICAR-Indian Veterinary Research Institute, Izatnagar. The peak early (Emax) and late (Amax) transmitral filling velocities were 61.75±2.93 and 42.17±2.52 cm/s, respectively. The mean early (Emean) and late (Amean) transmitral filling velocities were 31.67±1.45 and 21.86±1.26 cm/s, respectively. The velocity time integrals of transmitral filling during early ventricular filling (VTIE) and atrial contraction (VTIA) were 8.22±0.29 and 4.52±0.39 cm, respectively. The peak early (PPGE) and late (PPGA) transmitral filling pressure gradients were 1.58±0.15 and 0.75±0.08 mmHg, respectively. The mean early (MPGE) and late (MPGA) transmitral filling pressure gradients were 0.42±0.04 and 0.20±0.02 mmHg, respectively. Early (ETE)andlate (ETA) transmitral filling ejection time were 0.27±0.01 and 0.21±0.02 s, respectively. Emax/Amax, VTIE: VTIA ETE: ETA and PPGE: PPGA ratios were 1.50±0.05, 2.11±0.23, 1.43±0.15 and 2.30±0.17, respectively. The peak (AOVmax), mean (AOVmean), velocity time integral (VTIAO), peak systolic pressure gradient (PPGAO), mean systolic pressure gradient (MPGAO), and ejection time (ETAO) of the aortic flow were 87.59±5.54 cm/s, 43.68±2.87 cm/s, 10.94±0.80 cm, 3.19±0.39 AO mmHg, 0.80±0.10 mmHg and 0.25±0.01s, respectively. These pulsed-wave Doppler echocardiographic cardiac dimension reference values in Muzaffarnagari sheep could serve as a reference for physiological and cardiovascular studies in this breed.

Echocardiographic evaluation of cardiac function in cynomolgus monkeys over a wide age range.

Various cardiovascular diseases can be detected and diagnosed using echocardiography. The demand for cardiovascular system research using nonhuman primates is increasing, but echocardiographic references for nonhuman primates are limited. This report describes the first comparison of echocardiographic reference values in 247 normal cynomolgus monkeys (135 females, 112 males) over a wide age range. Echocardiography, electrocardiography, blood pressure and chest X-ray images were acquired under immobilization with intramuscular ketamine hydrochloride, then cardiac structure, function, and flow velocity were assessed. Cardiac hormone levels were also tested. We found that cardiac structures positively correlated with weight, that the size of these structures stabilized after reaching maturity and that cardiac output increased according to heart size. In contrast, fractional shortening of the left ventricle, ejection fraction and flow velocity showed no significant correlations with weight or age, and age and E wave correlated negatively. These findings appear sufficiently similar to those in humans to suggest that cynomolgus monkeys can serve as a suitable model of human cardiac disease. Our data should also prove useful for surveying cardiac dysfunction in monkeys.

Reference ranges for fetal cardiac measurements from two-dimensional echocardiography in Taiwanese population

Background Currently available fetal echocardiographic reference values are derived mainly from North American and European population studies, and there is a lack of reference values for fetal echocardiographic measurement in Taiwanese population. The aim of this study was to establish normal ranges of echocardiographic measurements in healthy Taiwanese fetuses. Methods From September 2016 till December 2017, a total of 599 healthy pregnant Taiwanese with the estimated gestational age from 14 to 38 weeks were enrolled voluntarily for this observational study. They were divided into 13 groups according to the gestational age at two weeks' interval. Standard two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries of the developing fetuses. Results A total of 575 healthy fetuses were enrolled. In contrast to other studies, our sample was more evenly distributed for estimated gestational age (p Conclusions This is the first study providing echocardiographic reference ranges and nomograms for Taiwanese fetuses. Computing z-scores from nomograms helps in standardizing comparisons and adds additional prognostic information to the diagnosis of congenital heart disease.

Normal echocardiographic measurements in a Turkish population: The Healthy Heart ECHO-TR Trial.

Objective:Normal reference values for the cardiac chambers are widely based on cohorts from European or American populations. In this study, we aimed to obtain normal echocardiographic measurements of healthy Turkish volunteers to reveal the age, gender, and geographical region dependent differences between Turkish populations and other populations.Methods:Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination. Blood biochemical parameters were also obtained for all patients on admission. The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used to assess the echocardiographic cardiac chamber quantification.Results:The study included 1154 volunteers (men: 609; women: 545), with a mean age of 33.5±11 years. Compared to men, women had a smaller body surface area, lower blood pressure and heart rate, lower hemoglobin, total cholesterol, lower low-density lipoprotein (LDL) levels, and higher high density lipoprotein (HDL) levels. Cardiac chambers were also smaller in women and their size varied with age. When we compared the regions in Turkey, the lowest values of left cardiac chamber indices were seen in the Marmara region and the highest values were observed in the Mediterranean region. Regarding the right cardiac indices, the Mediterranean region reported the lowest values, while the Black Sea region and the Eastern Anatolia region reported the highest values.Conclusion:This is the first study that evaluates the normal echocardiographic reference values for a healthy Turkish population. These results may provide important reference values that could be useful in routine clinical practice as well as in further clinical trials.

Echocardiographic Reference Values for Right-Sided Heart Chambers in a Healthy Population

Echocardiographic Reference Values for Right-Sided Heart Chambers in a Healthy Population