What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Healthy volunteers (n=96). Intervention: Gradient echo cardiac magnetic resonance imaging (CMR) at 1.5 T. Primary outcome: Age and gender specific normal values for left ventricular mass, volumes, and function.

January 21, 2009Open Access

Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study

Key Result

Gradient echo cardiac magnetic resonance imaging at 1.5 T revealed that left ventricular volumes and mass rise in adolescence and decline with age in healthy individuals aged 11 to 81 years.

Study Design

Type

Cross-Sectional (n=96)

Multicenter

Structured PICO

Population

96 healthy Caucasian volunteers (76 adults aged 21-81, 20 children aged 11-15; 50 male). Key inclusion: normal ECG, normal blood pressure (SBP ≤ 140 mmHg and DBP ≤ 90 mmHg), no history of systolic or diastolic hypertension. Key exclusion: previous or current cardiovascular, systemic, metabolic disease, BMI ≥ 30, visually overt aortic or mitral valve regurgitation, or treatment with medication.

Intervention

Gradient echo cardiac magnetic resonance imaging (CMR) at 1.5 T

Outcome

Age and gender specific normal reference values for left ventricular mass (LVM), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF)surrogate

This study establishes age- and gender-specific normal reference ranges for left ventricular mass, volumes, and function using 1.5 T gradient echo CMR, which is essential for distinguishing normal physiological variation from cardiac disease.

Limitations

Regurgitation in the aortic or mitral valve was only assessed visually in long axis CMR images.
The number of included subjects in each gender and decade is less than the minimally suggested n = 10 for determining reference values.
The normal values provided are specific to gradient echo sequences at 1.5 T and may differ from those obtained using steady-state free precession sequences.

Abstract

BACKGROUND: Knowledge about age-specific normal values for left ventricular mass (LVM), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) by cardiac magnetic resonance imaging (CMR) is of importance to differentiate between health and disease and to assess the severity of disease. The aims of the study were to determine age and gender specific normal reference values and to explore the normal physiological variation of these parameters from adolescence to late adulthood, in a cross sectional study. METHODS: Gradient echo CMR was performed at 1.5 T in 96 healthy volunteers (11-81 years, 50 male). Gender-specific analysis of parameters was undertaken in both absolute values and adjusted for body surface area (BSA). RESULTS: Age and gender specific normal ranges for LV volumes, mass and function are presented from the second through the eighth decade of life. LVM, ESV and EDV rose during adolescence and declined in adulthood. SV and EF decreased with age. Compared to adult females, adult males had higher BSA-adjusted values of EDV (p = 0.006) and ESV (p < 0.001), similar SV (p = 0.51) and lower EF (p = 0.014). No gender differences were seen in the youngest, 11-15 year, age range. CONCLUSION: LV volumes, mass and function vary over a broad age range in healthy individuals. LV volumes and mass both rise in adolescence and decline with age. EF showed a rapid decline in adolescence compared to changes throughout adulthood. These findings demonstrate the need for age and gender specific normal ranges for clinical use.

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