Distribution and categorization of left ventricular measurements in the general population: results from the population-based Gutenberg Heart Study.
BACKGROUND
Echocardiography, the dominant imaging modality for quantification of left ventricular metrics, has undergone continuing development in the past few decades. However, given the lack of population-based data, current guidelines are still based on restricted and small data sets analyzed with methods including expert opinion. This work presents empirically derived reference values from a large-scale, epidemiologic study conducted with state-of-the-art imaging technology and methods.


RESULTS
The distribution of echocardiographic measurements of the left ventricle was analyzed in a population-based sample of 5000 mid-Europeans from the Gutenberg Heart Study in Germany. The randomly selected, noninstitutionalized sample provides data on apparently healthy individuals, as well as on those with prevalent disease. Standardized echocardiograms were recorded in a comprehensive data set at a single site with centralized training and certification of sonographers. Sex-specific reference limits and categories indicating the grade of deviation from the reference were calculated, and nomograms were created by quantile regression. Detailed information is given on the association between left ventricular geometry and age.


CONCLUSIONS
The rapidly evolving echocardiographic technology with persistent improvements in image quality and new measurement conventions require the evaluation of new reference limits for left ventricular metrics. The present investigation formulates reference limits and nomograms from state-of-the-art technology and methods based on a large population-based data set. The distribution of echocardiographic measures of left ventricular geometry presents, in part, nonlinear associations with age, which should be the subject of future investigations.
Wild
Philipp S
PS
Department of Medicine II, Institute for Clinical Chemistry, Johannes Gutenberg-University Mainz, Mainz, Germany. philipp.wild@unimedizin-mainz.de
Sinning
Christoph R
CR
Roth
Alexander
A
Wilde
Sandra
S
Schnabel
Renate B
RB
Lubos
Edith
E
Zeller
Tanja
T
Keller
Till
T
Lackner
Karl J
KJ
Blettner
Maria
M
Vasan
Ramachandran S
RS
Münzel
Thomas
T
Blankenberg
Stefan
S
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left