Advertisement

European Radiology

, Volume 28, Issue 9, pp 3996–4005 | Cite as

Reference ranges of left ventricular structure and function assessed by contrast-enhanced cardiac MR and changes related to ageing and hypertension in a population-based study

  • Robin Bülow
  • Till Ittermann
  • Marcus Dörr
  • Axel Poesch
  • Sönke Langner
  • Henry Völzke
  • Norbert Hosten
  • Marc Dewey
Cardiac
  • 180 Downloads

Abstract

Objectives

Reference ranges of left ventricular (LV) parameters from cardiac magnetic resonance (CMR) were established to investigate the impact of ageing and hypertension as important determinants of cardiac structure and function.

Methods

One thousand five hundred twenty-five contrast-enhanced CMRs were conducted in the Study of Health in Pomerania. LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV), ejection fraction (LVEF), and myocardial mass (LVMM) were determined using long- and short-axis steady-state free-precession sequences. The reference population was defined as participants without late enhancement, hypertension, and prior cardiovascular diseases. Reference ranges were established by quantile regression (5th and 95th percentile) and compared with an additional sample of treated and untreated hypertensives.

Results

LV volumes in the reference population (n = 634, 300 males, 334 females, 52.1 ± 13.3 years) aged between 20-69 years were lower with higher age (p = 0.001), whereas LVEFs were higher (p ≤ 0.020). LVMM was lower only in males (p = 0.002). Compared with the reference population, hypertension was associated with lower LVEDV in males (n = 258, p ≤ 0.032). Antihypertensive therapy was associated with higher LVEF in males (n = 258, +2.5%, p = 0.002) and females (n = 180, +2.1%, p = 0.001).

Conclusions

Population-based LV reference ranges were derived from contrast-enhanced CMR. Hypertension-related changes were identified by comparing these values with those of hypertensives, and they might be used to monitor cardiac function in these patients.

Key Points

• Left ventricular function changed slightly but significantly between 20-69 years.

• Reference values of BSA-indexed myocardial mass decreased with age in males.

• Hypertension was associated with lower LV end-diastolic volume only in males.

• CMR may allow assessing remodelling related to hypertension or antihypertensive treatment.

Keywords

Magnetic resonance imaging Reference value Left ventricle Ageing Hypertension 

Abbreviations

ATC

Anatomical therapeutic chemical

BSA

Body surface area

CI

Confidence interval

CMR

Cardiac magnetic resonance

ECG

Electrocardiogram

LGE

Late gadolinium enhancement

LV

Left ventricular

LVEDV

Left ventricular end-diastolic volume

LVEF

Left ventricular ejection fraction

LVESV

Left ventricular end-systolic volume

LVMM

Left ventricular myocardial mass

LVSV

Left ventricular stroke volume

MR

Magnetic resonance

SD

Standard deviation

SHIP

Study of Health in Pomerania

SSFP

Steady-state free precession

TE

Echo time

TR

Repetition time

Notes

Funding

This study has received funding from the following institutions: Federal Ministry of Education and Research, the Ministry of Cultural Affairs as well as the Social Ministry of the Federal State of Mecklenburg-West Pomerania. Magnetic resonance imaging examinations were supported by Siemens Healthineers, Siemens Healthcare GmbH (Erlangen, Germany).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Robin Bülow, MD (buelowr@uni-greifswald.de).

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, Till Ittermann, has significant statistical expertise.

Informed consent

The local ethics committee approved the study, and written informed consent was obtained from all participating volunteers before contrast-enhanced cardiac magnetic resonance imaging.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The cardiac magnetic resonance imaging sub-study was part of the population-based Study of Health in Pomerania (SHIP), a project conducted in northeast Germany. To date nothing has been previously published about the cardiac magnetic resonance imaging data in SHIP although the study population is a sample of the whole-body MR imaging project, which has produced numerous scientific publications.

Methodology

• retrospective

• cross-sectional study/observational

• performed at one institution

Supplementary material

330_2018_5345_MOESM1_ESM.docx (94.7 mb)
ESM 1 (DOCX 96926 kb)

References

  1. 1.
    Miller AL, Dib C, Li L et al (2012) Left ventricular ejection fraction assessment among patients with acute myocardial infarction and its association with hospital quality of care and evidence-based therapy use. Circ Cardiovasc Qual Outcomes 5:662–671CrossRefPubMedGoogle Scholar
  2. 2.
    Mewton N, Opdahl A, Choi EY et al (2013) Left ventricular global function index by magnetic resonance imaging--a novel marker for assessment of cardiac performance for the prediction of cardiovascular events: the multi-ethnic study of atherosclerosis. Hypertension 61:770–778CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Grebe O, Kestler HA, Merkle N et al (2004) Assessment of left ventricular function with steady-state-free-precession magnetic resonance imaging. Reference values and a comparison to left ventriculography. Z Kardiol 93:686–695CrossRefPubMedGoogle Scholar
  4. 4.
    Fiechter M, Fuchs TA, Gebhard C et al (2013) Age-related normal structural and functional ventricular values in cardiac function assessed by magnetic resonance. BMC Med Imaging 13:6CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU (2003) Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging 17:323–329CrossRefPubMedGoogle Scholar
  6. 6.
    Cain PA, Ahl R, Hedstrom E et al (2009) Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study. BMC Med Imaging 9:2CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER et al (2015) Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson 17:29CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Natori S, Lai S, Finn JP et al (2006) Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity. AJR Am J Roentgenol 186:S357–S365CrossRefPubMedGoogle Scholar
  9. 9.
    Chuang ML, Gona P, Hautvast GL et al (2014) CMR reference values for left ventricular volumes, mass, and ejection fraction using computer-aided analysis: the Framingham Heart Study. J Magn Reson Imaging 39:895–900CrossRefPubMedGoogle Scholar
  10. 10.
    Petersen SE, Aung N, Sanghvi MM et al (2017) Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort. J Cardiovasc Magn Reson 19:18CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Volzke H, Alte D, Schmidt CO et al (2011) Cohort profile: the study of health in Pomerania. Int J Epidemiol 40:294–307CrossRefPubMedGoogle Scholar
  12. 12.
    Hegenscheid K, Kuhn JP, Volzke H, Biffar R, Hosten N, Puls R (2009) Whole-body magnetic resonance imaging of healthy volunteers: pilot study results from the population-based SHIP study. Rofo 181:748–759CrossRefPubMedGoogle Scholar
  13. 13.
    (2014) Observational studies: getting clear about transparency. PLoS Med 11:e1001711Google Scholar
  14. 14.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470CrossRefPubMedGoogle Scholar
  15. 15.
    Kieback AG, Lorbeer R, Wallaschofski H et al (2012) Claudication, in contrast to angina pectoris, independently predicts mortality risk in the general population. Vasa 41:105–113CrossRefPubMedGoogle Scholar
  16. 16.
    Juergens KU, Grude M, Maintz D et al (2004) Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. Radiology 230:403–410CrossRefPubMedGoogle Scholar
  17. 17.
    Schulz-Menger J, Bluemke DA, Bremerich J et al (2013) Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 15:35CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Du Bois D, Du Bois EF (1989) A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition 5:303–311 discussion 312-303PubMedGoogle Scholar
  19. 19.
    Giavarina D (2015) Understanding Bland Altman analysis. Biochem Med (Zagreb) 25:141–151CrossRefGoogle Scholar
  20. 20.
    Wei Y, Pere A, Koenker R, He X (2006) Quantile regression methods for reference growth charts. Stat Med 25:1369–1382CrossRefPubMedGoogle Scholar
  21. 21.
    Hudsmith LE, Petersen SE, Francis JM, Robson MD, Neubauer S (2005) Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J Cardiovasc Magn Reson 7:775–782CrossRefPubMedGoogle Scholar
  22. 22.
    Yeon SB, Salton CJ, Gona P et al (2015) Impact of age, sex, and indexation method on MR left ventricular reference values in the Framingham Heart Study offspring cohort. J Magn Reson Imaging 41:1038–1045CrossRefPubMedGoogle Scholar
  23. 23.
    Pfluger HB, Maeder MT, LaGerche A, Taylor AJ (2010) One- and two-dimensional estimation of right and left ventricular size and function-comparison with cardiac magnetic resonance imaging volumetric analysis. Heart Lung Circ 19:541–548CrossRefPubMedGoogle Scholar
  24. 24.
    Berkovic P, Hemmink M, Parizel PM, Vrints CJ, Paelinck BP (2010) MR image analysis: Longitudinal cardiac motion influences left ventricular measurements. Eur J Radiol 73:260–265CrossRefPubMedGoogle Scholar
  25. 25.
    de Simone G, Devereux RB, Izzo R et al (2013) Lack of reduction of left ventricular mass in treated hypertension: the strong heart study. J Am Heart Assoc 2:e000144CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Eng J, McClelland RL, Gomes AS et al (2016) Adverse Left Ventricular Remodeling and Age Assessed with Cardiac MR Imaging: The Multi-Ethnic Study of Atherosclerosis. Radiology 278:714–722CrossRefPubMedGoogle Scholar
  27. 27.
    Ambale-Venkatesh B, Lima JA (2015) Cardiac MRI: a central prognostic tool in myocardial fibrosis. Nat Rev Cardiol 12:18–29CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018
corrected publication March 2018

Authors and Affiliations

  1. 1.Institute for Diagnostic Radiology and Neuroradiology, University MedicineErnst Moritz Arndt University GreifswaldGreifswaldGermany
  2. 2.Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University MedicineErnst Moritz Arndt University GreifswaldGreifswaldGermany
  3. 3.Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University MedicineErnst Moritz Arndt UniversityGreifswaldGermany
  4. 4.DZHK (German Centre for Cardiovascular Research)GreifswaldGermany
  5. 5.Institute for RadiologyCharité Medical SchoolBerlinGermany

Personalised recommendations