title: Size matters! Impact of age, sex, height, and weight on the normal heart size.
abstract: BACKGROUND
  Therapeutic decisions in cardiology are determined frequently by cardiac chamber size. To decide whether cardiac dimensions are still in the normal range, reliable reference values are needed. However, published reference values mostly refer to historical cohorts using motion-mode measurements and have not been adjusted for sex or age. The impact of body size was only vaguely addressed. The importance of such adjustments is illustrated by studies, which show that smaller individuals and women are at risk of delayed treatment and impaired outcome when currently used reference values are applied. The aim of the present study was to assess the impact of body size, sex, and age on the normal heart size.
  
  
  RESULTS
  We prospectively studied 622 individuals (52.7% women; 17-91 years; 143-200 cm; 32-240 kg) without cardiac disease by standard transthoracic echocardiography. Multivariable linear regression analyses of the impact of sex, age, height, and weight on cardiac chamber size were performed. By multivariable regression analysis (n=500), all 4 variables independently influenced cardiac chamber size. The validity of cardiac dimensions predicted by the regression model was tested prospectively in a validation cohort (n=122). A calculator is proposed that estimates cardiac dimensions on the basis of the regression analysis.
  
  
  CONCLUSIONS
  Sex, height, weight, and age significantly affect the normal heart size. These parameters need to be considered when cutoff values indicating the need for treatment or even surgery are established.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology and Department of Medical Statistics, Medical University of Vienna, Vienna, Austria; and Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Pfaffenberger
authors.forename: Philipp
authors.initials: P
authors.lastname: Bartko
authors.forename: Alexandra
authors.initials: A
authors.lastname: Graf
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pernicka
authors.forename: Jamil
authors.initials: J
authors.lastname: Babayev
authors.forename: Emina
authors.initials: E
authors.lastname: Lolic
authors.forename: Diana
authors.initials: D
authors.lastname: Bonderman
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Julia
authors.initials: J
authors.lastname: Mascherbauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001827:Body Height; D001835:Body Weight; D002306:Cardiac Volume / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D012737:Sex Factors; D055815:Young Adult
keywords: age; body size; echocardiography; sex