title: Reference ranges for and determinants of right ventricular area in healthy adults by two-dimensional echocardiography.
abstract: BACKGROUND
  The right ventricular (RV) area is important for diagnosis and follow-up in patients with various diseases, such as in pulmonary hypertension.
  
  
  OBJECTIVE
  The aim of this study was to define the reference ranges of the end-diastolic RV area in healthy adults and to assess the determining factors.
  
  
  METHODS
  In the first part of the study 860 healthy subjects (37.6% female; mean age 28 ± 5.84; 395 endurance athletes, 255 strength athletes and 210 non-athletes) were prospectively assessed. In the second part we performed a pooled analysis of studies published between 1979 and 2014 describing the RV area in healthy subjects (n = 5,248). Statistical analysis included the calculation of reference ranges and the analysis of determining factors.
  
  
  RESULTS
  Mean end-diastolic RV areas in 860 healthy subjects were significantly larger in endurance athletes (25.1 ± 2.0 cm(2)) compared with strength athletes (22.9 ± 1.7 cm(2)) and non-athletes (16.7 ± 2.0 cm(2), p < 0.001). In the synopsis of both data sets, mean end-diastolic RV area was significantly larger in European/American males (17 cm(2)) compared with females (14 cm(2), p < 0.001) and in Asian males (16 cm(2)) compared with females (13 cm(2), p < 0.001). The area increased with body surface area and older age.
  
  
  CONCLUSIONS
  This is the largest data set to define RV size in healthy adults aged <50 years. RV area was determined by age, gender, body surface area, ethnicity and high-level exercise training. High standard deviations resulted in high values for the upper limit of the reference range, which might therefore not be useful as cut-off values for screening purposes. Gender- and ethnicity-specific reference ranges should be used. Further studies in subjects aged >50 years as well as in children are needed.
authors.affiliation: Centre for Pulmonary Hypertension, Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Grünig
authors.forename: Johanna
authors.initials: J
authors.lastname: Biskupek
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.forename: Nicola
authors.initials: N
authors.lastname: Ehlken
authors.forename: Benjamin
authors.initials: B
authors.lastname: Egenlauf
authors.forename: Johannes
authors.initials: J
authors.lastname: Weidenhammer
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Marra
authors.forename: Antonio
authors.initials: A
authors.lastname: Cittadini
authors.forename: Christine
authors.initials: C
authors.lastname: Fischer
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D000328:Adult; D000367:Age Factors; D044466:Asian People; D056352:Athletes / Q000706:statistics & numerical data*; D001830:Body Surface Area; D004452:Echocardiography; D005260:Female; D064368:Healthy Volunteers; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D012737:Sex Factors; D044465:White People; D055815:Young Adult