Clinical Investigation
Right Ventricular Size and Function
Right Heart Assessment by Echocardiography: Gender and Body Size Matters

https://doi.org/10.1016/j.echo.2012.08.013Get rights and content

Background

Published reference values for echocardiographic measurements of right-heart dimensions and function do not stratify for gender and body size. The aim of this study was therefore to assess the impact of gender and biometric characteristics on right-heart dimensions and function.

Methods

From the echocardiography database at a tertiary care center, 1,625 subjects (mean age, 44 ± 14 years; 47% men) with normal echocardiographic findings between 2000 and 2009 were identified. Gender differences and association with body surface area were assessed retrospectively for right atrial long-axis and short-axis dimensions, right ventricular short-axis dimension, end-diastolic and end-systolic right ventricular area, right ventricular fractional area change, and tricuspid annular plane systolic excursion. The impact of normal values stratified for gender and body surface area was tested in 24 patients with moderate-sized to large atrial septal defects.

Results

All dimensional right-heart measurements were significantly lower in women. Differences became smaller when measurements were indexed for body surface area, but significant differences persisted, particularly for right ventricular end-diastolic area (7.9 ± 1.6 vs 8.7 ± 1.8 cm2/m2, P < .001) and right ventricular end-systolic area (4.0 ± 1.2 vs 4.7 ± 1.4 cm2/m2, P < .001). Fractional area change and tricuspid annular plane systolic excursion indexed to body surface area were significantly higher in women (50 ± 7% vs 46 ± 9% and 14 ± 3 vs 12 ± 2 mm/m2, respectively, P < .001 for both comparisons). The use of upper reference ranges for end-diastolic right ventricular area stratified for gender and body surface area improved the detection of enlarged right ventricles in patients with moderate-sized to large atrial septal defects (92% vs 54%, P < .007).

Conclusions

Gender and body surface area are important determinants of right ventricular dimensions and systolic function as measured on two-dimensional echocardiography. The investigators thus propose the use of measurements indexed to body surface area, with upper and lower reference ranges stratified for gender.

Section snippets

Study Population

Patients were identified from the echocardiography database of a tertiary care center. In this database, for each patient, the indication for the study, measured height and weight, and a predefined set of echocardiographic measurements are recorded. For patients with structurally and functionally normal hearts, the study results are coded as “normal” by a staff cardiologist. The criteria for classification of echocardiographic results as normal are sinus rhythm, absence of structural

Study Population

From a total of 46,367 echocardiographic studies in adult patients performed between 2000 and 2009, in 2,743 (6%), the results were coded as normal. Of these subjects, 1,118 were excluded from the present analysis because of potentially confounding preexisting disease. Reasons for exclusion were coronary artery disease in 168, lung disease in 97, connective tissue disorders in 211, inherited myopathies in 16, human immunodeficiency virus infection in 20, studies performed in patients in the

Discussion

Right-heart dimensions and simple measurements of right ventricular systolic function such as FAC and TAPSE are commonly used for echocardiographic assessment of right-heart dimensions and systolic function. Yet normal reference values for these measurements are based on results from numerous, at times small studies. The number of normal subjects used to define reference ranges for right ventricular dimensions and function range from 267 subjects for right atrial long-axis dimension (derived

Conclusions

Gender and body surface area are important determinants of right ventricular dimensions and systolic function as measured on two-dimensional echocardiography. We thus propose the use of measurements indexed to body surface area, with upper and lower reference ranges stratified for gender.

References (23)

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