Distribution and categorization of echocardiographic measurements in relation to reference limits - The Framingham Heart Study: Formulation of a height- and sex-specific classification and its prospective validation
Distribution and categorization of echocardiographic measurements in relation to reference limits - The Framingham Heart Study: Formulation of a height- and sex-specific classification and its prospective validation
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DOI：
10.1161/01.cir.96.6.1863
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发表时间：
1997-09-16
期刊：
影响因子：
37.8
通讯作者：
Benjamin, EJ
中科院分区：
文献类型：
--
作者：
Vasan, RS;Larson, MG;Benjamin, EJ
背景：尽管超声心动图测量的分类广泛，但对于超过参考限值的分划值尚无标准化的指导方针。方法和结果我们采用回归分析方法，在Framingham心脏研究的健康参考样本（n=1099）中建立心脏m型测量（左室[LV]质量、左室壁厚度、左室和左房尺寸）的性别和身高特异性参考限。然后，我们在一个广泛的样本（n=4957）中检查了测量值的分布，并根据与身高和性别特定参考限的偏差增加以及广泛样本的第95、98和99百分位值（分别为类别0到4）对测量值进行了分类。为了验证分类方案，我们使用多变量比例风险回归来评估左室质量和左室壁厚类别与心血管事件风险的关系，以及左房大小与房颤风险的关系。在平均7.7年的随访期间，587例受试者出现新的心血管疾病事件，166例受试者出现新发心房颤动。在对已知危险因素进行调整后，每一类左室壁厚和左室质量发生心血管疾病的风险分别为1.2倍和1.3倍，每一类左房大小发生心房颤动的风险分别为1.6倍。通过基于社区的大型研究样本，我们提出了一种分类方案，该方案为超声心动图测量的划分提供了标准化和有效的框架。如果采用，分类方案应促进超声心动图实验室测量描述的统一性，提高临床医生测量的可理解性。
Background Despite widespread categorization of echocardiographic measurements, there are no standardized guidelines for partitioning values exceeding reference limits.Methods and Results We used regression analyses to develop sex- and height-specific reference limits for cardiac M-mode measurements (left ventricular [LV] mass, LV wall thickness, and LV and left atrial dimensions) in a healthy reference sample (n=1099) from the Framingham Heart Study. We then examined the distribution of measurements in a broad sample (n=4957) and classified the measurements according to increasing deviation from the height-and sex-specific reference limits and the 95th, 98th, and 99th percentile values for the broad sample (categories 0 through 4, respectively). To validate the categorization scheme, we used multi variable proportional-hazards regression to assess the relations of LV mass and LV wall thickness categories to risk of cardiovascular events and the relations of left atrial size to risk of atrial fibrillation. During a mean follow-up period of 7.7 years, 587 subjects developed new cardiovascular disease events, and 166 subjects developed new-onset atrial fibrillation. After adjustment for known risk factors, there was a 1.2- and 1.3-fold risk of cardiovascular disease events per category of LV wall thickness and LV mass, respectively, and a 1.6-fold risk of atrial fibrillation per category of left atrial size.Conclusions Using a large community-based study sample, we propose a classification scheme that provides a standardized and validated framework for partitioning echocardiographic measurements. If adopted, the categorization scheme should promote uniformity in describing measurements among echocardiographic laboratories and enhance the comprehensibility of measurements to clinicians.