Normal values of regional left ventricular myocardial thickness, mass and distribution-assessed by 320-detector computed tomography angiography in the Copenhagen General Population Study

  • Louise Hindsø
  • Andreas Fuchs
  • Jørgen Tobias Kühl
  • Emma Julia P. Nilsson
  • Per Ejlstrup Sigvardsen
  • Lars Køber
  • Børge G. Nordestgaard
  • Klaus Fuglsang Kofoed
Original Paper

Abstract

Left ventricular (LV) hypertrophy is associated with cardiovascular complications and the geometry is important for prognosis. In some cardiovascular diseases, myocardial hypertrophy or dilation occurs regionally without modifying the global size of the heart. It is therefore relevant to determine regional normal reference values of the left ventricle. The aim of this study was to derive reference values of regional LV myocardial thickness (LVMT) and mass (LVMM) from a healthy study group of the general population using cardiac computed tomography angiography (CCTA). We wanted to introduce LV myocardial distribution (LVMD) as a measure of regional variation of the LVMT. Moreover, we wanted to determine whether these parameters varied between men and women. We studied 568 (181 men; 32%) adults, free of cardiovascular disease and risk factors, who underwent 320-detector CCTA. Mean age was 55 (range 40–84) years. Regional LVMT and LVMM were measured, according to the American Heart Association’s 17 segment model, using semi-automatic software. Mean LVMT were 6.6 mm for men and 5.4 mm for women (p < 0.001). The normal LV was thickest in the basal septum (segment 3; men = 8.3 mm; women = 7.2 mm) and thinnest in the mid-ventricular anterior wall (segment 7; men = 5.6 mm; women = 4.5 mm) for both men and women. However, the regional LVMD differed between men and women, with the LV being most heterogenic in women. The normal human LV is morphologically heterogenic, and showed same overall pattern but different regional distribution for men and women. This study introduces LVMD and provides gender specific reference values for regional LVMT, LVMM, and LVMD.

Keywords

Cardiovascular computed tomography Left ventricular myocardium Dimensions Healthy population Reference values 

Notes

Acknowledgements

The research was supported financially by Snedkermester Sophus Jacobsen og hustru Astrids Jacobsens Fond and the Danish Heart Foundation (Grant No. 14-R97-A5017-22871). The authors wish to thank chief radiographer Kim Madsen, Department of Radiology and his staff of radiographers and nurses working at the scanner for their enthusiastic technical and logistical support.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest.

Ethical approval

The Danish National Committee on Biomedical Research Ethics approved the research protocol (H-KF-01-144/01) and all patients gave oral and written consent before enrollment.

References

  1. 1.
    Baltabaeva A, Marciniak M, Bijnens B et al (2008) Regional left ventricular deformation and geometry analysis provides insights in myocardial remodelling in mild to moderate hypertension. Eur J Echocardiogr 9:501–508PubMedGoogle Scholar
  2. 2.
    Florea VG, Mareyev VY, Samko AN et al (1999) Left ventricular remodelling: common process in patients with different primary myocardial disorders. Int J Cardiol 68:281–287CrossRefPubMedGoogle Scholar
  3. 3.
    Kaplinsky E (1994) Significance of left ventricular hypertrophy in cardiovascular morbidity and mortality. Cardiovasc Drugs Ther 8(Suppl 3):549–556CrossRefPubMedGoogle Scholar
  4. 4.
    Levy D, Garrison RJ, Savage DD et al (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322:1561–1566CrossRefPubMedGoogle Scholar
  5. 5.
    Bang CN, Gerdts E, Aurigemma GP et al (2014) Four-group classification of left ventricular hypertrophy based on ventricular concentricity and dilatation identifies a low-risk subset of eccentric hypertrophy in hypertensive patients. Circ Cardiovasc Imaging 7:422–429CrossRefPubMedGoogle Scholar
  6. 6.
    Koren MJ, Devereux RB, Casale PN et al (1991) Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 114:345–352CrossRefPubMedGoogle Scholar
  7. 7.
    Verma A, Meris A, Skali H et al (2008) Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) echocardiographic study. JACC Cardiovasc Imaging 1:582–591CrossRefPubMedGoogle Scholar
  8. 8.
    Verdecchia P, Porcellati C, Zampi I et al (1994) Asymmetric left ventricular remodeling due to isolated septal thickening in patients with systemic hypertension and normal left ventricular masses. Am J Cardiol 73:247–252CrossRefPubMedGoogle Scholar
  9. 9.
    Tuseth N, Cramariuc D, Rieck ÅE et al (2010) Asymmetric septal hypertrophy—a marker of hypertension in aortic stenosis (a SEAS substudy). Blood Press 19:140–144CrossRefPubMedGoogle Scholar
  10. 10.
    Safar ME, Lehner JP, Vincent MI et al (1979) Echocardiographic dimensions in borderline and sustained hypertension. Am J Cardiol 44:930–935CrossRefPubMedGoogle Scholar
  11. 11.
    Henry WL, Clark CE, Epstein SE (1973) Asymmetric septal hypertrophy. Echocardiographic identification of the pathognomonic anatomic abnormality of IHSS. Circulation 47:225–233CrossRefPubMedGoogle Scholar
  12. 12.
    Ganau A, Devereux RB, Roman MJ et al (1992) Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 19:1550–1558CrossRefPubMedGoogle Scholar
  13. 13.
    Kawel N, Turkbey EB, Carr JJ et al (2012) Normal left ventricular myocardial thickness for middle-aged and older subjects with steady-state free precession cardiac magnetic resonance: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging 5:500–508CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cury RC (2015) President’s page: Worldwide expansion of cardiac CT–an impressive growth in recent years. J Cardiovasc Comput Tomogr 9:77–79CrossRefPubMedGoogle Scholar
  15. 15.
    Fuchs A, Kühl JT, Lønborg J et al (2012) Automated assessment of heart chamber volumes and function in patients with previous myocardial infarction using multidetector computed tomography. J Cardiovasc Comput Tomogr 6:325–334CrossRefPubMedGoogle Scholar
  16. 16.
    Fuchs A, Mejdahl MR, Kühl JT et al (2016) Normal values of left ventricular mass and cardiac chamber volumes assessed by 320-detector computed tomography angiography in the Copenhagen General Population Study. Eur Heart J Cardiovasc Imaging 17:1009–1017Google Scholar
  17. 17.
    Nordestgaard BG, Palmer TM, Benn M et al (2012) The effect of elevated body mass index on ischemic heart disease risk: causal estimates from a Mendelian randomisation approach. PLoS Med 9:e1001212CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Levy D, Savage DD, Garrison RJ et al (1987) Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 59:956–960CrossRefPubMedGoogle Scholar
  19. 19.
    Mancia G, Fagard R, Narkiewicz K et al (2014) 2013 ESH/ESC practice guidelines for the management of arterial hypertension. Blood Press 23:3–16CrossRefPubMedGoogle Scholar
  20. 20.
    Perk J, De Backer G, Gohlke H et al (2012) European guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Int J Behav Med 19:403–488CrossRefPubMedGoogle Scholar
  21. 21.
    Fabian J, Epstein EJ, Coulshed N (1972) Duration of phases of left ventricular systole using indirect methods. I. Normal subjects. Br Heart J 34:874–881CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542CrossRefPubMedGoogle Scholar
  23. 23.
    Masshoff W, Scheidt D, Reimers HF (1967) Virchows Archiv Für Pathologische Anatomie Und Physiologie Und Für Klinische Medizin. Virchows Arch Pathol Anat Physiol. Klin Med 342:184–189Google Scholar
  24. 24.
    Lang RM, Bierig M, Devereux RB et al (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108CrossRefPubMedGoogle Scholar
  25. 25.
    Bogaert J, Rademakers FE (2001) Regional nonuniformity of normal adult human left ventricle. Am J Physiol Heart Circ Physiol 280:H610–H620PubMedGoogle Scholar
  26. 26.
    Stolzmann P, Scheffel H, Leschka S et al (2008) Reference values for quantitative left ventricular and left atrial measurements in cardiac computed tomography. Eur Radiol 18:1625–1634CrossRefPubMedGoogle Scholar
  27. 27.
    Dannenberg AL, Levy D, Garrison RJ (1989) Impact of age on echocardiographic left ventricular mass in a healthy population (the Framingham Study). Am J Cardiol 64:1066–1068CrossRefPubMedGoogle Scholar
  28. 28.
    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
  29. 29.
    Cain PA, Ahl R, Hedstrom E et al (2007) Physiological determinants of the variation in left ventricular mass from early adolescence to late adulthood in healthy subjects. Clin Physiol Funct Imaging 27:255–262CrossRefPubMedGoogle Scholar
  30. 30.
    Payne JR, James LE, Eleftheriou KI et al (2007) The association of left ventricular mass with blood pressure, cigarette smoking and alcohol consumption; data from the LARGE Heart study. Int J Cardiol 120:52–58CrossRefPubMedGoogle Scholar
  31. 31.
    Bischoff B, Hein F, Meyer T et al (2009) Trends in radiation protection in CT: present and future status. J Cardiovasc Comput Tomogr 3(Suppl 2):S65–S73CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Louise Hindsø
    • 1
  • Andreas Fuchs
    • 1
  • Jørgen Tobias Kühl
    • 1
  • Emma Julia P. Nilsson
    • 1
  • Per Ejlstrup Sigvardsen
    • 1
  • Lars Køber
    • 1
  • Børge G. Nordestgaard
    • 2
  • Klaus Fuglsang Kofoed
    • 1
    • 3
  1. 1.Department of Cardiology, The Heart Center, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Radiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark

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