Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort

Abstract

BackgroundCardiovascular magnetic resonance (CMR) is the gold standard method for the assessment of cardiac structure and function. Reference ranges permit differentiation between normal and pathological states. To date, this study is the largest to provide CMR specific reference ranges for left ventricular, right ventricular, left atrial and right atrial structure and function derived from truly healthy Caucasian adults aged 45–74.MethodsFive thousand sixty-five UK Biobank participants underwent CMR using steady-state free precession imaging at 1.5 Tesla. Manual analysis was performed for all four cardiac chambers. Participants with non-Caucasian ethnicity, known cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Remaining participants formed the healthy reference cohort; reference ranges were calculated and were stratified by gender and age (45–54, 55–64, 65–74).ResultsAfter applying exclusion criteria, 804 (16.2%) participants were available for analysis. Left ventricular (LV) volumes were larger in males compared to females for absolute and indexed values. With advancing age, LV volumes were mostly smaller in both sexes. LV ejection fraction was significantly greater in females compared to males (mean ± standard deviation [SD] of 61 ± 5% vs 58 ± 5%) and remained static with age for both genders. In older age groups, LV mass was lower in men, but remained virtually unchanged in women. LV mass was significantly higher in males compared to females (mean ± SD of 53 ± 9 g/m2 vs 42 ± 7 g/m2). Right ventricular (RV) volumes were significantly larger in males compared to females for absolute and indexed values and were smaller with advancing age. RV ejection fraction was higher with increasing age in females only. Left atrial (LA) maximal volume and stroke volume were significantly larger in males compared to females for absolute values but not for indexed values. LA ejection fraction was similar for both sexes. Right atrial (RA) maximal volume was significantly larger in males for both absolute and indexed values, while RA ejection fraction was significantly higher in females.ConclusionsWe describe age- and sex-specific reference ranges for the left ventricle, right ventricle and atria in the largest validated normal Caucasian population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0327-9) contains supplementary material, which is available to authorized users.

Cardiac Structure–Function MRI in Patients After Heart Transplantation

“…Magnetic resonance imaging (MRI) has promise as an alternative noninvasive imaging modality due to its capability to quantify regional changes in left ventricular (LV) structure and function. In addition to standard LV functional measures, such as ejection fraction (EF), by 2D CINE steady state free precession (SSFP) imaging, MR can assess regional LV changes. Edema, fibrosis, and interstitial expansion can be evaluated using T 2 ‐mapping and pre‐ and postgadolinium (Gd) contrast T 1 ‐mapping (to quantify extracellular volume [ECV] fraction) .…”

Variation in cardiovascular magnetic resonance myocardial contouring: Insights from an international survey

“…b Includes QMass Medis Medical, GE Healthcare (Suiteheart), CIM (University of Auckland). 4 The panels demonstrate contouring of the ventricles using identical SSFP cine short axis images, from base to apex at end-diastole and end-systole, below which are tables of the respective LV parameters. For detailed contouring, those papillary muscles and trabeculations continuous with the LV endocardial border were included in mass and excluded from the blood pool.…”

“…time constraints, access to software with "thresholding" capability (ie, intensity-based segmentation), availability of vendor-specific reference ranges without information detailing papillary muscle inclusion/exclusion, or failure to read and understand the reference methods. It could also reflect the lack of a representative example of the contouring method in the reference article; most, [3][4][5][6] but not all, 7,8 published reference ranges include exemplar figures, which should be obligatory for any future reference technique publication. We have performed volumetric and mass analyses in 20 consecutive patients (57 AE 16 years; male 70%) with hypertrophic cardiomyopathy (HCM), using the two most common postprocessing methodologies based on our survey data (Table 2).…”

“…3 In contrast, in 2017 the UK Biobank project published normal reference ranges using ellipsoid "smoothed" contours of the compacted endocardial border, including 800 healthy subjects. 4 It is unclear which of these methodologies are being used in real-life clinical practice. To address this issue, we conducted an international survey examining contemporaneous cardiac MRI reporting practice.An electronic survey was sent to all members of the British Society of Cardiovascular Magnetic Resonance (BSCMR) and the Australia and New Zealand Working Group for Cardiovascular Magnetic Resonance (ANZCMR).…”

Atrial Fibrillation, Past and Future: From a Stroke Non-Entity to an Over-Targeted Cause

“…Fibrosis in the atrium and ventricle can now be detected and quantified by Cardiac MRI [11], and by histological analysis [16, 17]. …”