Right Ventricular Normal Measurements: Time to Index?

doi:10.1016/j.echo.2012.06.015

Journal of the American Society of Echocardiography

Volume 25, Issue 12, December 2012, Pages 1259-1267

https://doi.org/10.1016/j.echo.2012.06.015 Get rights and content

Background

Despite the common practice of indexing left ventricular dimensions to body surface area, there remains a lack of indexed normal right ventricular (RV) two-dimensional caliper measurements. Variations in ranges for normal RV dimensions have been shown to exist, and indexing RV dimensions according to body surface area may help reduce this and provide a standardization useful for clinical practice. The aim of this study was to prospectively establish both absolute and indexed normal dimensions for the right ventricle using standardized positions in a multiethnic population. Furthermore, the effects of both gender and ethnicity on both the absolute and indexed results were also evaluated.

Methods

Two hundred five healthy volunteers from four ethnic backgrounds (Indian, Chinese, Malay, and European) were prospectively enrolled and underwent two-dimensional echocardiography according to a set protocol. Ten measurements were made in conjunction with previous research. Intraobserver and interobserver and test-retest variability was assessed using coefficients of variation and intraclass correlation coefficients.

Results

Male absolute results exceeded female absolute results in 90% of measurements (P = .003). European absolute results (male and female) were significantly larger in up to eight of 10 measurements (P = .01). When indexed, female results became significantly larger (P < .001) than male results. Indexing was able to reduce the number of statistical differences between male ethnic groups. Measurements showed good levels of intraobserver and interobserver variability for apical and short-axis measurements.

Conclusions

Gender and body surface area play an important part in the determination of normal RV reference ranges, whereas ethnicity has little influence. Results using the suggested RV markers for these measurements showed good repeatability.

Section snippets

Echocardiographic Assessment

For both qualitative and quantitative evaluation of the right ventricle, multiple projections are required to clearly assess each of the chamber components. American Society of Echocardiography (ASE) and European Association of Echocardiography (EAE) guidelines discuss the assessment of the right ventricle using both previously described methods and expert consensus,5, 6 but unlike the left ventricle, there was no inclusion of results indexing RV values to BSA.

More recent ASE and EAE

Study Population

Two hundred five healthy volunteers from four ethnic backgrounds (Chinese, European, Indian, and Malay) were prospectively enrolled and underwent standardized echocardiographic assessment. Full exclusion criteria are shown in Table 1. Ages ranged from 19 to 71 years (mean, 42 years; 53% men). Screening of volunteers involved 12-lead electrocardiography, a health questionnaire, and a physical examination.

Initial participant ethnicity was chosen on the basis of the largest national demographic

Results

Of the 205 volunteers, three (1.4%) were excluded from the study because of cardiac anomalies. Image acquisition ranged from 71.2% to 92%.

Table 3 summarizes the volunteer demographics. All subsequent analysis of both normalized and absolute measurements was conducted on gender-specific data. The results, organized by ethnic group, are shown in Tables 4 and 5 for absolute measurements and Tables 6 and 7 for results normalized to BSA.

BSA was found to be significantly higher in men than in women

Discussion

The aim of this study was to ascertain the importance of indexing results to BSA and the determination of normal values for a range of ethnic groups split by gender. The results highlight a number of considerations when assessing the right ventricle. First, although there are no significant differences in functional two-dimensional RV echocardiographic parameters, there is extensive disparity between male and female RV dimensions across an extensive range of measurements. Second, factors such

Conclusions

RV dimensions, both absolute and indexed, are presented here in a large, diverse population, demonstrating the influence of gender and BSA and providing more robust measurements that correlate well with recent findings.¹⁰ We have shown the potential for indexed results in reducing many of the differences in RV dimensions encountered by both gender and ethnicity, with gender-specific reference ranges presented in Table 8.

Acknowledgments

We are grateful to sonographers Joseph Sparey and Amy Szewil for their contributions in the collection and analysis of data for this report.

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: This study was funded by the Royal United Hospital Research and Development Fund.

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Clinical InvestigationRight Ventricular Size and FunctionRight Ventricular Normal Measurements: Time to Index?

Background

Methods

Results

Conclusions

Section snippets

Echocardiographic Assessment

Study Population

Results

Discussion

Conclusions

Acknowledgments

J Am Soc Echocardiogr

J Am Coll Cardiol

Am Heart J

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

Ann Thorac Surg

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Echocardiography in the assessment of right heart function

Eur J Echocardiogr

The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment

Anesth Analg

Clinical Investigation
Right Ventricular Size and Function
Right Ventricular Normal Measurements: Time to Index?