Normal echocardiographic measurements in Turkish population: The Healthy Heart ECHO-TR Trial

Abstract

Objective: Normal reference values for the cardiac chambers are widely based on cohorts from European or American populations. In this study, we aimed to obtain normal echocardiographic measurements of healthy Turkish volunteers to reveal the age, gender, and geographical region dependent differences between Turkish populations and other populations. Methods: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination. Blood biochemical parameters were also obtained for all patients on admission. The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used to assess the echocardiographic cardiac chamber quantification. Results: The study included 1154 volunteers (men: 609; women: 545), with a mean age of 33.5±11 years. Compared to men, women had a smaller body surface area, lower blood pressure and heart rate, lower hemoglobin, total cholesterol, lower low-density lipoprotein (LDL) levels, and higher high density lipoprotein (HDL) levels. Cardiac chambers were also smaller in women and their size varied with age. When we compared the regions in Turkey, the lowest values of left cardiac chamber indices were seen in the Marmara region and the highest values were observed in the Mediterranean region. Regarding the right cardiac indices, the Mediterranean region reported the lowest values, while the Black Sea region and the Eastern Anatolia region reported the highest values. Conclusion: This is the first study that evaluates the normal echocardiographic reference values for a healthy Turkish population. These results may provide important reference values that could be useful in routine clinical practice as well as in further clinical trials.

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population : ECHO-DOP-TR Trial

“…In conclusion, the current data obtained from healthy Turkish volunteers are comparable with most previous studies in this era (2,3,5,6,10,11,13,18). E and A waves of mitral annulus and also E/A ratios were greater compared to European registries, but these differences were not statisitically significant.…”

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO‐DOP‐TR Trial

“…In conclusion, the current data obtained from healthy Turkish volunteers are comparable with most previous studies in this era 2,3,5,6,10,11,13,18 . E and A waves of mitral annulus and also E / A ratios were greater compared to European registries, but these differences were not statistically significant.…”

“…Recently, we, for the first time in Turkey, have reported two‐dimensional echocardiographic normal reference ranges for cardiac chamber quantification in a large cohort of Turkish individuals 5 . Besides the chamber sizes, essential data regarding the relationship between these measurements and age, gender, body surface area and geographical region‐dependent differences have been provided.…”

Standardization of normal values for cardiac chamber size in echocardiography

“…In Japan, the Japanese Normal Values for Echocardiographic Measurements Project (JAMP) study examined 700 healthy Japanese subjects and found that LV dimensions were larger for males than for females, but also showed that values for males were smaller when indexed to BSA, and that 2D LV volume for males was larger than for females even when the values were indexed to BSA [8]. Most of the subsequent national or regional studies on normal reference values for LV size showed results consistent with those of the JAMP study [9][10][11][12][13][14][15][16], while some showed only minor differences [17]. As for the relationship between LV size and age, 2D LV volume generally decreased with age for both genders [8,11,16,[18][19][20], which has been confirmed in a meta-analysis based [21].…”

“…LaBounty et al, on the other hand, reported that LV dimensions for Asians and Hispanics were larger than those for Whites [22]. Some other studies suggest that slight differences exist in normal values for LV size even within a single race or country, so that place of residence may also play a role [17,23]. Recently, the WASE Normal Values study used a uniformed measurement protocol to examine in two core laboratories data for over 2000 normal subjects enrolled worldwide, and found only minor differences for LV size among races and countries, although the normal reference values recommended in the current guidelines need to be adjusted [15].…”