Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort.
BACKGROUND
Cardiovascular magnetic resonance (CMR) is the gold standard method for the assessment of cardiac structure and function. Reference ranges permit differentiation between normal and pathological states. To date, this study is the largest to provide CMR specific reference ranges for left ventricular, right ventricular, left atrial and right atrial structure and function derived from truly healthy Caucasian adults aged 45-74.


METHODS
Five thousand sixty-five UK Biobank participants underwent CMR using steady-state free precession imaging at 1.5 Tesla. Manual analysis was performed for all four cardiac chambers. Participants with non-Caucasian ethnicity, known cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Remaining participants formed the healthy reference cohort; reference ranges were calculated and were stratified by gender and age (45-54, 55-64, 65-74).


RESULTS
After applying exclusion criteria, 804 (16.2%) participants were available for analysis. Left ventricular (LV) volumes were larger in males compared to females for absolute and indexed values. With advancing age, LV volumes were mostly smaller in both sexes. LV ejection fraction was significantly greater in females compared to males (mean ± standard deviation [SD] of 61 ± 5% vs 58 ± 5%) and remained static with age for both genders. In older age groups, LV mass was lower in men, but remained virtually unchanged in women. LV mass was significantly higher in males compared to females (mean ± SD of 53 ± 9 g/m2vs 42 ± 7 g/m2). Right ventricular (RV) volumes were significantly larger in males compared to females for absolute and indexed values and were smaller with advancing age. RV ejection fraction was higher with increasing age in females only. Left atrial (LA) maximal volume and stroke volume were significantly larger in males compared to females for absolute values but not for indexed values. LA ejection fraction was similar for both sexes. Right atrial (RA) maximal volume was significantly larger in males for both absolute and indexed values, while RA ejection fraction was significantly higher in females.


CONCLUSIONS
We describe age- and sex-specific reference ranges for the left ventricle, right ventricle and atria in the largest validated normal Caucasian population.
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. s.e.petersen@qmul.ac.uk.
Steffen E
SE
Petersen
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Nay
N
Aung
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Mihir M
MM
Sanghvi
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Filip
F
Zemrak
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Kenneth
K
Fung
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Jose Miguel
JM
Paiva
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
Jane M
JM
Francis
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Mohammed Y
MY
Khanji
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
Elena
E
Lukaschuk
William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
Aaron M
AM
Lee
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
Valentina
V
Carapella
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.|Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Young Jin
YJ
Kim
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
Paul
P
Leeson
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
Stefan K
SK
Piechnik
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
Stefan
S
Neubauer
D000367:Age Factors; D000368:Aged; D016279:Atrial Function, Left; D016280:Atrial Function, Right; D018070:Biological Specimen Banks; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012016:Reference Values; D015203:Reproducibility of Results; D012737:Sex Factors; D013318:Stroke Volume; D006113:United Kingdom; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D044465:White People
Atrial function; Cardiovascular magnetic resonance; Reference values; Ventricular function