Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study.
OBJECTIVE
Availability of normative reference values for cardiac chamber quantitation is a prerequisite for accurate clinical application of echocardiography. In this study, we report normal reference ranges for cardiac chambers size obtained in a large group of healthy volunteers accounting for gender and age. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following chamber quantitation protocols approved by the European Association of Cardiovascular Imaging.


METHODS
A total of 734 (mean age: 45.8 ± 13.3 years) healthy volunteers (320 men and 414 women) were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was performed on all subjects following pre-defined protocols. There were no gender differences in age or cholesterol levels. Compared with men, women had significantly smaller body surface areas, and lower blood pressure. Quality of echocardiographic data sets was good to excellent in the majority of patients. Upper and lower reference limits were higher in men than in women. The reference values varied with age. These age-related changes persisted for most parameters after normalization for the body surface area.


CONCLUSIONS
The NORRE study provides useful two-dimensional echocardiographic reference ranges for cardiac chamber quantification. These data highlight the need for body size normalization that should be performed together with age-and gender-specific assessment for the most echocardiographic parameters.
Department of Cardiology, St Marianna University, School of Medicine, Kawasaki, Japan.
Seisyou
S
Kou
Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Luis
L
Caballero
GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, Liege, Belgium.
Raluca
R
Dulgheru
Département de Cardiology, CHU de Brabois, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 54000 Nancy, France.
Damien
D
Voilliot
Cardiology Department, Centro Hospitalar São João/University of Porto Medical School, Porto, Portugal.
Carla
C
De Sousa
Echocardiography Laboratory of Adult Cardiology Department of the JOANN Medical Center, Tbilisi, Georgia.
George
G
Kacharava
Noninvasive Diagnostics Department, Onassis Cardiac Surgery Center, Athens, Greece.
George D
GD
Athanassopoulos
Laboratory of Cardiovascular Ecography, Cardiology Department, S. Andrea Hospital, La Spezia, Italy.
Daniele
D
Barone
Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana 'G.Monasterio'-Ospedale Del Cuore, Massa, Italy.
Monica
M
Baroni
Echocardiographylaboratory, Hospital da Luz, Lisbon, Portugal.
Nuno
N
Cardim
Unidad de Imagen Cardiovascular, ICV, Hospital Clinico San Carlos, Madrid, Spain.
Jose Juan
JJ
Gomez De Diego
Echokardiographie-Labore des Universitätsklinikums AöR, Department of Cardiology-Angiology, University of Leipzig, Leipzig, Germany.
Andreas
A
Hagendorff
GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, Liege, Belgium.
Christine
C
Henri
Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, Sofia, Bulgaria.
Krasimira
K
Hristova
Cardiology Department, La Paz Hospital, Madrid, Spain.
Teresa
T
Lopez
CHU Limoges, Hôpital Dupuytren, Pôle Coeur-Poumon-Rein, Service Cardiologie, Limoges, France.
Julien
J
Magne
Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Gonzalo
G
De La Morena
'Carol Davila' University of Medicine and Pharmacy, Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania.
Bogdan A
BA
Popescu
Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Martin
M
Penicka
VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Istanbul, Turkey.
Tolga
T
Ozyigit
Laboratorio de Ecocardiografia Hospital de Cruces-Barakaldo, Barakaldo, Spain.
Jose David
JD
Rodrigo Carbonero
SheikhKhalifa Medical City, PO Box 51900, Abu Dhabi, UAE.
Alessandro
A
Salustri
Echocardiography Unit, AZ Maria Middelares, Gent, Belgium.
Nico
N
Van De Veire
Medical Department Cardiology, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Germany.
Ralph Stephan
RS
Von Bardeleben
Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Dragos
D
Vinereanu
Echocardiography Laboratory, Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium.
Jens-Uwe
JU
Voigt
University Hospital Ramón y Cajal, Madrid, Spain.
Jose Luis
JL
Zamorano
CIC-IT U 804, CHU Rennes, Université Rennes 1, Service de Cardiologie, Chu Rennes, France.
Erwan
E
Donal
Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
Roberto M
RM
Lang
Department of Cardiac, Thoracic and Vascular Sciences University of Padova, School of Medicine, Padova, Italy.
Luigi P
LP
Badano
GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, Liege, Belgium plancellotti@chu.ulg.ac.be.
Patrizio
P
Lancellotti
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D055815:Young Adult
Chamber size and function; Reference values; Two-dimensional echocardiography