DOI: 10.1161/circ.148.suppl_1.11656 ISSN: 0009-7322

Abstract 11656: Relation Between Method of Indexation for Normal Chamber Dimensions and Association With Functional Measures: The Multi-Ethnic Study of Atherosclerosis

Jordan B Strom, Monica Mukherjee, Lauren Nelson, Benjamin H Freed, Julius Gardin, Jonathan Afilalo, Sanjiv J Shah
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Normalization of echocardiographic chamber measurements for body surface area (BSA) may result in biased estimation of dimensions in obese or sarcopenic individuals. While alternative scaling systems that circumvent this issue have been proposed, there remains a dearth of information on normal values indexed to scaling parameters other than BSA and whether they vary by sex or race/ethnicity.

Methods: Of 3032 individuals who underwent echocardiography at Exam 6 in the Multi-Ethnic Study of Atherosclerosis (MESA), we identified 608 without apparent cardiopulmonary or cardiometabolic disease (69.5 ± 7.0 years, 46.2% male, 47.5% White). Normal values for left and right heart variables across a variety of ratiometric (BSA, body mass index [BMI], height) and allometric (height 1.6 , and height 2.7 ) scaling systems were defined as the mean value ± 1.96 standard deviations and compared across sex and race/ethnicity categories. In the broader cohort (N = 3032), we evaluated the correlation of indexed parameters and functional measures (NT-proBNP, 6-minute walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire [KCCQ]).

Results: Height 2.7 had the best overall mean correlation with functional measures (mean correlation -0.12 ± 0.04 with KCCQ; mean correlation -0.15 ± 0.08 with 6MWD) and was superior to BSA for KCCQ and 6MWD (both p < 0.001) but not NT-proBNP (both p > 0.05). Mean correlations for allometric scaling were greater than ratiometric scaling for KCCQ and 6MWD (both p < 0.001) but not NT-proBNP (both p > 0.05). For 6MWD, mean correlations for allometric scaling (p = 0.001) but not ratiometric scaling (p = 0.8) were more negative (suggestive of impaired function) than unindexed measures.

Conclusions: In this a multi-ethnic cohort of community-dwelling older adults free from apparent cardiopulmonary or cardiometabolic diseases, we provide normative indexed values for commonly measured echocardiographic parameters across a variety of indexation methods and show that they differ across sex and race/ethnicity categories. Allometric height 2.7 correlated best with functional measures and was superior to BSA. Current chamber quantification guidelines should be updated to reflect normative data on scaled parameters.

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