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
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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.
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.
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).
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.
• 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.
KeywordsMagnetic resonance imaging Reference value Left ventricle Ageing Hypertension
Anatomical therapeutic chemical
Body surface area
Cardiac magnetic resonance
Late gadolinium enhancement
Left ventricular end-diastolic volume
Left ventricular ejection fraction
Left ventricular end-systolic volume
Left ventricular myocardial mass
Left ventricular stroke volume
Study of Health in Pomerania
Steady-state free precession
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
The scientific guarantor of this publication is Robin Bülow, MD (firstname.lastname@example.org).
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.
The local ethics committee approved the study, and written informed consent was obtained from all participating volunteers before contrast-enhanced cardiac magnetic resonance imaging.
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.
• cross-sectional study/observational
• performed at one institution
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