Normal Values of Echocardiographic Parameters in Relation ... - J-Stage

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Watanabe Hospital, Osaka, 8Tenri Hospital, Tenri, 9Yamaguchi Uni- versity, Ube ... Mailing address: Junichi Yoshikawa, MD, Osaka Ekisaikai Hospital,. 2-1-10 ...

Circ J 2008; 72: 1859 – 1866

Normal Values of Echocardiographic Parameters in Relation to Age in a Healthy Japanese Population The JAMP Study Masao Daimon, MD1; Hiroyuki Watanabe, MD2; Yukio Abe, MD3; Kumiko Hirata, MD4; Takeshi Hozumi, MD5; Katsuhisa Ishii, MD6; Hiroshi Ito, MD7; Katsuomi Iwakura, MD7; Chisato Izumi, MD8; Masunori Matsuzaki, MD9; Shinichi Minagoe, MD10; Haruhiko Abe, MD11; Kazuya Murata, MD9; Satoshi Nakatani, MD12; Kazuaki Negishi, MD13; Ken Yoshida, MD14; Kazuaki Tanabe, MD15; Nobuhiro Tanaka, MD16; Kotaro Tokai, MD17; Junichi Yoshikawa, MD14; for the JAMP Study Investigators Background Normal values for echocardiographic measurements and the relationship between these parameters and age in a large Japanese population are still unknown. Methods and Results A total of 700 healthy Japanese aged 20–79 years underwent 2-dimensional and Doppler echocardiography at collaborating institutions. The respective mean values obtained in men and women were as follows: septal wall thickness, 0.9±0.1 and 0.8±0.1 cm; posterior wall thickness, 0.9±0.1 and 0.8±0.1 cm; left ventricular (LV) diastolic diameter, 4.8±0.4 and 4.4±0.3 cm; LV systolic diameter, 3.0±0.4 and 2.8±0.3 cm; LV diastolic volume, 93±20 and 74±17 ml; LV systolic volume, 33±20 and 25±7 ml; LV ejection fraction, 64±5 and 66±5%; maximum left atrial (LA) volume, 42±14 and 38±12 ml. Aortic root diameter, LV wall thickness, and LV mass slightly increased with age, whereas indexed LA volume did not vary with age. Diastolic parameters assessed by mitral inflow and mitral annular velocities declined with age, as previously reported. Conclusions Normal values of echocardiographic measurements in a large Japanese population are reported for the first time; several systolic and diastolic parameters varied with age. These results provide important reference values that should be useful in routine clinical practice as well as in clinical trials. (Circ J 2008; 72: 1859 – 1866) Key Words: Cardiac volume; Echocardiography; Ventricular function

E

chocardiography is now recognized as an integral diagnostic tool that enables noninvasive quantification of cardiac chamber size, ventricular mass, and function in the clinical setting. Furthermore, technological advancement in Doppler echocardiography enables quantitative assessment of ventricular diastolic function as well as systolic function. Thus, echocardiography has become an important cardiac imaging technique in a number of clinical trials evaluating the efficacy of drug treatments or new therapeutic strategies. A guideline for quantifying cardiac chamber size and function using echocardiography, and references values for (Received February 27, 2008; revised manuscript received June 11, 2008; accepted June 26, 2008; released online September 29, 2008) 1Juntendo University, Tokyo, 2Sakakibara Heart Institute, Fuchu, 3Osaka City General Hospital, 4Higashisumiyoshi Morimoto Hospital, 5Osaka City University, 6Kansai Electric Power Hospital, 7Sakurabashi Watanabe Hospital, Osaka, 8Tenri Hospital, Tenri, 9Yamaguchi University, Ube, 10National Hospital Organization Kagoshima Medical Center, Kagoshima, 11National Hospital Organization Osaka Minami Medical Center, Kawachinagano, 12National Cardiovascular Center, Suita, 13Gunma University, Maebashi, 14Osaka Ekisaikai Hospital, Osaka, 15Kobe City Medical Center General Hospital, Kobe, 16Tokyo Medical University and 17Nihon University, Tokyo, Japan Mailing address: Junichi Yoshikawa, MD, Osaka Ekisaikai Hospital, 2-1-10 Honda, Nishi-ku, Osaka 550-0022, Japan. E-mail: [email protected] All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: [email protected]

Circulation Journal Vol.72, November 2008

these echocardiographic measurements, were provided by the American Society of Echocardiography in conjunction with the European Association of Echocardiography.1 Likewise, Doppler echocardiographic criteria for assessing left ventricular (LV) diastolic function were provided by the Canadian Consensus,2 European3 and American Medical Association guidelines,4 and diastolic function parameters were reported to decline gradually with age.5 However, most of these data are derived from American and European populations and because physical6,7 and racial8–10 differences can influence cardiac chamber size and function, it is important to evaluate the echocardiographic parameters in other populations. Reference values based on a large Asian population have not been previously reported, although some investigators have reported these values in a small population.11 In addition, most studies that have investigated the relationship between age and cardiac chamber size and function have focused on a few parameters and have not assessed all of them in a large population. Accordingly, we designed and conducted a multicenter study, the Japanese Normal Values for Echocardiographic Measurements Project (JAMP) study, to determine the normal values for echocardiographic measurements and evaluate the relationship between these parameters and age in a large, healthy Japanese population.

DAIMON M et al.

1860

Fig 1. Measurements of right ventricular end-diastolic midcavity diameter (RVD) and area (RV area) from the apical 4-chamber view. LV, left ventricle; LA, left atrium; RA, right atrium.

Fig 2. Measurements of the left atrial diameter (LAD4CV) and length (LAL), and the right atrial diameter (RAD) and length (RAL) from the apical 4-chamber view, and the left atrial diameter from the parasternal long-axis view (LADPLAX). RV, right ventricular; LV, left ventricular; Ao, aorta.

Table 1 Clinical Characteristics Stratified by Age Age group (years) No. Heart rate, beats/min Systolic pressure, mmHg Diastolic pressure, mmHg BSA, kg/m2

Men 20–29

30–39

40–49

50–59

Women 60–69

70–79

20–29

30–39

40–49

50–59

60–69

70–79

84 79 88 72 40 20 63 79 66 60 35 14 62±9 66±8 67±9 64±9 63±9 62±8 63±9 63±10 65±8 63±9 64±8 66±12 117±11 120±9 119±8 118±9 119±11 123±12 109±13 112±9 113±10 120±10 119±9 125±9 70±7 72±8 74±8 74±8 72±8 76±9 68±10 69±7 68±6 72±8 71±6 73±8 1.8±0.1 1.8±0.1 1.8±0.2 1.7±0.1 1.7±0.1 1.7±0.1 1.5±0.1 1.5±0.1 1.5±0.1 1.5±0.1 1.5±0.1 1.5±0.1

BSA, body surface area.

Methods Study Population We enrolled a total of 700 healthy volunteers, aged from 20 to 79 years (383 men: mean age 43.7±14.5 years; 317 women: mean age 43.5±14.5 years), at 17 collaborating institutions. A standard protocol for echocardiographic measurements was established for this study. Exclusion criteria were subjects with any history of hyperlipidemia, hypertension, diabetes mellitus, renal failure, cardiovascular

disease, abnormal electrocardiographic findings including cardiac arrhythmia and bundle branch block, or abnormal echocardiographic findings (LV wall motion abnormalities or significant valvular disease). Subjects with poor echocardiographic images or with significant fever, anemia, or high blood pressure (systolic ≥135 or diastolic ≥85 mmHg) at the time of echocardiographic examination or those under the influence of any agent that could affect echocardiographic measurements were also excluded. The study protocol was approved by the local hospital ethics committees, and inCirculation Journal Vol.72, November 2008

Circulation Journal Vol.72, November 2008 2.2±0.2 3.1±0.3 2.5±0.3 1.2±0.1 1.7±0.2 1.4±0.2 0.8±0.1 0.9±0.1 4.8±0.3 3.1±0.3 2.7±0.2 1.7±0.2 95±17 34±8 53±9 19±4 64±5 134±28 76±16 3.0±0.4 1.7±0.2 16±3 9±3 9±2 5±1 45±12

0.8±0.1 0.8±0.1

4.9±0.4 3.1±0.4 2.7±0.2 1.8±0.2

102±22 38±11 58±11 21±6 64±4 130±26 74±14

3.2±0.6 1.8±0.3 18±5 10±3 10±3 6±2 46±10

30–39

2.2±0.2 2.9±0.3 2.4±0.3 1.3±0.1 1.7±0.2 1.4±0.2

20–29

15±4 9±3 9±2 5±2 41±18

3.0±0.4 1.7±0.3

90±20 32±9 51±11 18±5 65±5 130±26 74±13

4.8±0.4 3.0±0.3 2.7±0.3 1.7±0.2

0.8±0.1 0.9±0.1

2.2±0.2 3.2±0.3 2.7±0.3 1.3±0.2 1.8±0.2 1.5±0.2

40–49

Men

15±5 9±3 9±3 5±2 44±11

3.1±0.5 1.8±0.3

89±18 32±10 52±11 19±5 64±6 136±32 79±20

4.7±0.3 2.9±0.4 2.7±0.2 1.7±0.3

0.9±0.1 0.9±0.1

2.3±0.3 3.3±0.3 2.8±0.3 1.3±0.2 1.9±0.2 1.6±0.2

50–59

15±3 8±2 9±2 5±1 44±10

2.9±0.4 1.7±0.3

89±19 31±8 53±11 18±5 66±5 135±31 80±17

4.6±0.4 2.8±0.3 2.8±0.3 1.6±0.2

0.9±0.1 0.9±0.1

2.3±0.4 3.3±0.4 2.9±0.3 1.3±0.3 1.9±0.4 1.7±0.4

60–69

15±3 9±3 9±2 5±2 42±12

3.1±0.5 1.8±0.3

82±17 28±9 49±11 17±6 66±6 138±31 82±17

4.5±0.3 2.7±0.2 2.7±0.2 1.6±0.2

1.0±0.1 0.9±0.1

2.3±0.2 3.5±0.5 2.9±0.3 1.3±0.2 2.1±0.2 1.8±0.2

70–79

16±4 9±3 9±2 5.1±2 44±13

3.1±0.5 1.8±0.3

93±20 33±20 53±11 19±5 64±5 133±28 76±16

4.8±0.4 3.0±0.4 2.7±0.2 1.7±0.2

0.9±0.1 0.9±0.1

2.2±0.3 3.1±0.4 2.6±0.3 1.3±0.2 1.8±0.3 1.5±0.3

Average

14±3 8±2 10±2 5±2 46±12

2.9±0.5 1.9±0.3

80±18 28±7 53±11 18±4 66±5 99±20 66±11

4.4±0.3 2.8±0.3 3.0±0.2 1.9±0.2

0.7±0.1 0.7±0.1

1.9±0.2 2.6±0.3 2.2±0.3 1.3±0.1 1.8±0.2 1.5±0.2

20–29

14±3 7±2 9±2 5±1 46±11

2.9±0.4 1.9±0.3

76±17 26±7 50±10 17±4 67±5 103±21 68±12

4.4±0.3 2.8±0.3 2.9±0.3 1.9±0.2

0.7±0.1 0.8±0.1

1.9±0.2 2.6±0.3 2.2±0.3 1.3±0.1 1.7±0.2 1.5±0.2

30–39

13±3 7±3 9±2 5±2 46±11

2.7±0.5 1.8±0.3

76±17 26±7 50±10 17±5 66±5 106±23 70±14

4.5±0.4 2.8±0.3 2.9±0.2 1.8±0.2

0.8±0.1 0.8±0.1

2.0±0.2 2.8±0.3 2.4±0.3 1.3±0.1 1.9±0.2 1.6±0.2

40–49

12±3 7±2 8±2 4±1 47±11

2.7±0.4 1.8±0.3

69±14 23±6 46±9 16±4 66±5 108±24 73±16

4.4±0.3 2.7±0.3 2.9±0.2 1.8±0.2

0.8±0.1 0.8±0.1

2.0±0.2 2.9±0.3 2.5±0.2 1.4±0.2 2.0±0.2 1.7±0.2

50–59

Women

12±3 7±2 8±2 5±1 43±11

2.7±0.3 1.8±0.3

71±19 24±7 48±11 16±5 65±6 113±21 76±13

4.5±0.3 2.7±0.3 3.1±0.2 1.8±0.2

0.8±0.1 0.9±0.1

2.0±0.3 3.0±0.3 2.6±0.3 1.4±0.2 2.0±0.3 1.8±0.2

60–69

LV, left ventricle; RV, right ventricle; LVDd, LV diastolic diameter; LVDs, LV systolic diameter; RVDd, RV diastolic diameter; RVDs, RV systolic diameter. Other abbreviation see in Table 1.

Aortic diameter At annulus, cm At sinuses of Valsalva, cm At sinotubular junction, cm At annulus/BSA, cm/m2 At sinuses of Valsalva/BSA, cm/m2 At sinotubular junction/BSA, cm/m2 LV wall thickness Septal thickness, cm Posterior wall thickness, cm LV dimensions LVDd, cm LVDs, cm LVDd/BSA, cm/m2 LVDs/BSA, cm/m2 LV volumes LV diastolic volume, ml LV systolic volume, ml LV diastolic volume/BSA, ml/m2 LV systolic volume/BSA, ml/m2 LV ejection fraction, % LV mass, g LV mass/BSA, g/m2 RV dimension RVDd, cm RVDd/BSA, cm/m2 RV area RV diastolic area, cm2 RV systolic area, cm2 RV diastolic area/BSA, cm2/m2 RV systolic area/BSA, cm2/m2 RV fractional area change, %

Age group (years)

Table 2 Aortic Diameter, LV Dimension, Volume, and Mass, and RV Dimension

12±4 7±2 9±3 5±2 45±10

2.8±0.8 1.9±0.6

65±18 21±6 45±14 14±5 69±5 110±23 76±16

4.3±0.4 2.6±0.4 3.0±0.4 1.8±0.3

0.9±0.1 0.9±0.1

2.1±0.3 2.9±0.3 2.6±0.3 1.4±0.2 2.0±0.2 1.8±0.2

70–79

13±3 7±2 9±2 5±1 46±11

2.8±0.5 1.9±0.3

74±17 25±7 49±11 17±5 66±5 105±22 70±14

4.4±0.3 2.8±0.3 3.0±0.2 1.8±0.2

0.8±0.1 0.8±0.1

2.0±0.2 2.8±0.3 2.4±0.3 1.3±0.2 1.9±0.2 1.6±0.2

Average

Normal Echo Values and Age-Related Changes in Japanese 1861

3.6±0.5 4.9±0.7 3.2±0.4 2.0±0.3 2.8±0.4 1.8±0.2 3.4±0.5 4.5±0.6 1.9±0.3 2.6±0.3 44±13 20±9 25±7 11±5

3.7±0.5 4.5±0.6 2.1±0.3 2.5±0.3 43±15 20±9 24±8 11±5

30–39

3.6±0.5 4.8±0.8 3.1±0.4 2.1±0.3 2.7±0.4 1.7±0.2

20–29

41±13 19±9 23±7 11±5

3.3±0.5 4.5±0.6 1.9±0.3 2.5±0.4

3.6±0.4 4.8±0.7 3.3±0.5 2.1±0.3 2.8±0.4 1.9±0.3

40–49

Men

42±14 20±9 24±7 12±5

3.4±0.5 4.6±0.5 2.0±0.3 2.7±0.3

3.6±0.5 5.0±0.7 3.3±0.4 2.1±0.3 2.9±0.4 1.9±0.3

50–59

39±11 20±9 23±7 12±5

3.2±0.5 4.6±0.6 1.9±0.4 2.7±0.4

3.5±0.6 4.7±0.8 3.3±0.4 2.1±0.4 2.8±0.5 2.0±0.3

60–69

41±17 19±10 24±9 11±5

3.3±0.6 4.7±0.6 1.9±0.4 2.8±0.5

3.6±0.6 5.1±0.7 3.3±0.6 2.1±0.4 3.0±0.5 2.0±0.3

70–79

42±14 20±9 24±7 11±5

3.4±0.5 4.5±0.6 2.0±0.3 2.6±0.3

3.6±0.5 4.9±0.7 3.2±0.4 2.1±0.3 2.8±0.4 1.9±0.3

Average

37±12 17±8 25±8 11±5

3.1±0.5 4.1±0.5 2.1±0.3 2.7±0.3

3.5±0.4 4.5±0.6 2.9±0.3 2.4±0.3 3.1±0.4 1.9±0.2

20–29

71±13 45±10 1.6±0.4 188±34 10.9±2.2 9.1±2.1 6.7±1.5 15.2±2.9 8.5±2.8 4.9±1.4 0.36±0.10

12.6±2.2 7.9±1.8 6.3±1.6

16.9±3.4 7.9±2.9 4.8±1.5 0.32±0.08

30–39

77±15 40±10 2.0±0.5 185±34

20–29

13.3±2.9 9.1±2.8 5.6±1.6 0.35±0.10

9.9±2.1 9.4±2.0 7.4±1.7

71±14 53±12 1.4±0.4 191±32

40–49

Men

11.3±2.8 9.2±2.5 6.1±1.6 0.35±0.12

8.4±2.2 9.6±2.1 8.2±2.0

66±16 59±12 1.2±0.3 200±53

50–59

9.6±2.7 10.7±3.3 7.0±2.4 0.35±0.08

7.3±1.8 10.1±1.8 9.0±2.6

63±14 67±14 1.0±0.2 217±44

60–69

9.5±1.9 11.6±4.0 6.4±1.7 0.37±0.10

6.7±2.1 10.0±1.8 9.5±3.3

60±16 74±16 0.8±0.2 221±35

70–79

13.5±3.9 9.0±3.0 5.5±1.8 0.35±0.10

10.0±2.8 9.2±2.1 7.4±2.2

70±15 52±15 1.5±0.5 195±40

Average

17.3±3.4 6.9±2.2 5.5±1.3 0.32±0.10

13.1±2.4 7.0±1.9 7.1±1.6

91±13 42±9 2.2±0.6 176±33

20–29

16.2±2.8 7.5±2.3 5.4±1.1 0.32±0.08

12.8±2.4 7.5±2.0 6.8±1.5

85±13 47±13 1.9±0.6 174±32

30–39

38±11 17±7 24±8 11±5

3.2±0.4 4.2±0.5 2.1±0.3 2.8±0.3

3.5±0.5 4.5±0.7 3.0±0.3 2.3±0.3 3.0±0.4 2.0±0.2

30–39

13.1±2.9 8.1±2.5 6.4±1.6 0.34±0.08

10.9±2.7 8.3±2.2 7.7±1.7

81±15 53±11 1.6±0.3 181±26

40–49

39±12 18±7 25±7 12±4

3.0±0.5 4.1±0.6 2.0±0.3 2.7±0.4

3.4±0.4 4.6±0.6 3.0±0.4 2.2±0.2 3.0±0.4 2.0±0.3

40–49

11.0±2.5 9.1±2.6 6.8±2.2 0.35±0.09

9.0±2.3 8.7±2.1 8.3±2.5

71±14 60±14 1.2±0.3 192±28

50–59

Women

39±14 18±8 26±9 12±5

3.0±0.4 4.2±0.6 2.0±0.3 2.8±0.5

3.5±0.5 4.5±0.8 3.1±0.4 2.4±0.4 3.1±0.6 2.1±0.3

50–59

Women

9.1±2.2 10.1±2.0 7.8±2.0 0.35±0.08

6.8±2.2 9.7±2.1 10.6±2.6

69±13 73±13 1.0±0.2 210±39

60–69

38±12 18±7 26±8 12±5

3.1±0.5 4.4±0.5 2.1±0.4 3.0±0.4

3.4±0.5 4.7±0.6 3.3±0.4 2.3±0.3 3.2±0.5 2.2±0.3

60–69

9.3±3.0 12.4±3.7 7.4±2.3 0.35±0.08

7.6±1.7 11.0±3.9 8.7±2.2

64±11 79±18 0.9±0.2 213±35

70–79

38±10 16±4 26±6 11±3

3.1±0.5 4.4±0.8 2.1±0.4 3.0±0.5

3.5±0.5 4.9±0.9 3.4±0.4 2.4±0.4 3.4±0.5 2.3±0.3

70–79

13.7±4.1 8.3±2.7 6.2±1.8 0.33±0.09

10.8±3.2 8.2±2.4 7.9±2.2

80±16 54±16 1.6±0.6 185±34

Average

38±12 17±7 25±8 12±5

3.1±0.5 4.2±0.6 2.1±0.3 2.8±0.4

3.5±0.5 4.6±0.7 3.1±0.3 2.3±0.3 3.1±0.5 2.0±0.3

Average

E, early diastolic mitral flow velocity; A, late diastolic mitral flow velocity; Dct, deceleration time of early diastolic mitral flow velocity; TDI, tissue Doppler imaging; e’ sept, early diastolic septal annular velocity; a’ sept, late diastolic septal annular velocity; e’ lat, early diastolic lateral annular velocity; a’ lat, late diastolic lateral annular velocity.

Mitral inflow parameters E, cm/s A, cm/s E/A Dct, ms TDI-mitral annulus Septal e’ sept, cm/s a’ sept, cm/s E/e’ sept Lateral e’ lat, cm/s a’ lat, cm/s E/e’ lat Tei index

Age group (years)

Table 4 Diastolic Function Parameters and Tei Index

LA, left atrium; RA, right atrium; 4CV, from apical 4-chamber view; PLAX, from parasternal long-axis view. Other abbreviation see in Tables 1,2.

LA dimensions LA diameter 4CV, cm LA length 4CV, cm LA diameter PLAX, cm LA diameter/BSA 4CV, cm/m2 LA length/BSA 4CV, cm/m2 LA diameter/BSA PLAX, cm/m2 RA dimensions RA diameter 4CV, cm RA length 4CV, cm RA diameter/BSA 4CV, cm/m2 RA length/BSA 4CV, cm/m2 LA volumes Maximum LA volume, ml Minimum LA volume, ml Maximum LA volume/BSA, ml/m2 Minimum LA volume/BSA, ml/m2

Age group (years)

Table 3 LA and RA Dimensions

1862 DAIMON M et al.

Circulation Journal Vol.72, November 2008

Normal Echo Values and Age-Related Changes in Japanese

1863

Table 5 Relationship of Echocardiographic Parameters to Age Men

Aortic diameters At annulus/BSA, cm/m2 At sinuses of Valsalva/BSA, cm/m2 At sinotubular junction/BSA, cm/m2 LV wall thickness Septal thickness, cm Posterior wall thickness, cm LV volumes LV diastolic volume/BSA, ml/m2 LV systolic volume/BSA, ml/m2 LV ejection fraction, % LV mass/BSA, g/m2 RV areas RV diastolic area/BSA, cm2/m2 RV systolic area/BSA, cm2/m2 RV fractional area change, % LA volumes Maximum LA volume/BSA, ml/m2 Minimum LA volume/BSA, ml/m2 Mitral inflow parameters E, cm/s A, cm/s E/A Dct, ms TDI-mitral annulus Septal e’ sept, cm/s a’ sept, cm/s E/e’ sept Lateral e’ lat, cm/s a’ lat, cm/s E/e’ lat Tei index

Women

r

p value

r

p value

0.17 0.47 0.47

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