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



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.

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.


Magnetic resonance imaging Reference value Left ventricle Ageing Hypertension 



Anatomical therapeutic chemical


Body surface area


Confidence interval


Cardiac magnetic resonance




Late gadolinium enhancement


Left ventricular


Left ventricular end-diastolic volume


Left ventricular ejection fraction


Left ventricular end-systolic volume


Left ventricular myocardial mass


Left ventricular stroke volume


Magnetic resonance


Standard deviation


Study of Health in Pomerania


Steady-state free precession


Echo time


Repetition time



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 (

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.


• 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)


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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

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