Age-, body surface area-, and sex-specific reference values for cardiovascular magnetic resonance imaging derived ventricular and atrial size and function for Chinese healthy children

BACKGROUND: Cardiovascular magnetic resonance (CMR) is crucial for the diagnosis and prognosis of heart disease. However, normal reference values for CMR-derived morphology parameters have not been established for Chinese children. We sought to establish reference values for ventricular and atrial size and function parameters using CMR in healthy Chinese children across a broad age range. METHODS: 3T CMR scans were performed in 191 healthy children, aged 4-18 years. We used balanced steady-state free precession sequence for analyzing chamber size and function. Reference percentile curves and tables were generated using the generalized additive model for location scale and shape. A meta-analysis was conducted to compare our results with those of relevant previously published studies. RESULTS: Boys generally had greater ventricular volumes and masses after normalization for body surface area (BSA) compared with girls. However, in the youngest age group (4-8 years), differences in volumes or masses between sexes were not found. Additionally, differences were not observed in left ventricular and right ventricular ejection fractions between sexes upon stratifying subjects based on age groups. However, after normalizing for BSA, only the maximal right atrial volume remained significantly greater in boys than that in girls. Age-specific and BSA-specific reference curves revealed non-linear relationships between age/BSA and cardiac parameters. Asian children exhibited significantly smaller chamber sizes compared to those seen in Caucasian children. CONCLUSION: We report normative CMR ventricular and atrial volume and function in Chinese children based on BSA, age, and sex, which can serve as a reference for future studies and clinical practice.