Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study
Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study
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DOI：
10.1016/j.echo.2019.08.012
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发表时间：
2019-11-01
影响因子：
6.5
通讯作者：
Schreckenberg, Marcus
中科院分区：
文献类型：
--
作者：
Asch, Federico M.;Miyoshi, Tatsuya;Schreckenberg, Marcus
背景资料：世界超声心动图联盟（WASE）正常值研究评估了来自多个国家和种族的个体，旨在描述可应用于全球社区的规范值，并确定不同国家和种族人群之间的差异和相似性。本报告特别侧重于二维（2D）左心室（LV）的尺寸，体积和收缩功能。方法：WASE正常值研究是一个多中心的国际，观察性，前瞻性，健康成年人的横断面研究。在每个国家招募的参与者根据年龄和性别均匀分布在六个预先确定的亚组中。根据美国超声心动图学会和欧洲心血管成像协会最近的指南，按照严格的协议采集和分析全面的2D经胸超声心动图。在WASE 2D核心实验室进行分析，包括2D LV尺寸、LV体积和LV射血分数（LVEF），采用双平面Simpson方法和全局纵向应变（GLS）。中位年龄为45岁（四分位距，32-65岁），42.8%为白色，41.8%为亚洲人，9.7%为黑人。男性受试者的LV尺寸和体积较大，而女性受试者的LVEF和GLS较高。LV尺寸的总体WASE正常范围小于指南中的范围，但WASE研究中LV容积的正常上限和LVEF的正常下限较高。反映LV尺寸（尺寸、质量和体积）的所有LV参数均存在显著的国家间差异，即使在索引到体表面积后也是如此，其中LV舒张末期和收缩末期体积的差异最大。澳大利亚的男女人数最多，而印度的男女人数最少。这一发现表明，除了性别和体表面积，在评价LV容量时还应考虑特定国家。LVEF和GLS的国家间差异较小，但仍具有统计学意义（P <0.05）。结论：男性的左心室尺寸和体积较大，而女性的LVEF和GLS较高。应调整当前指南推荐的LV容积和LVEF的正常范围。LV容量的国家间变异性显著，因此在定义正态性范围时应考虑国籍。
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.