Sex- and Age-Related Reference Values in Cardiology, with Annotations and Guidelines for Interpretation

  • Peter L. M. KerkhofEmail author
  • Richard A. Peace
  • Peter W. Macfarlane
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1065)


The definition of “abnormal” in clinical sciences is often based on so-called reference values which point to a range that experts by some sort of consensus consider as normal when looking at biological variables. Such a level is commonly calculated by taking (twice) the standard deviation from the mean, or considering certain percentiles. The suspicion or even confirmation of a disease is then established by demonstrating that the value measured exceeds the upper or lower reference value. As is often the case, the measurement accuracy may depend on the conditions and specific method employed to collect and analyze data. This implies that, for example, data assessed by 2D echocardiography possibly differ from those obtained by MRI and therefore require modality-specific reference values. In this review we summarize reference values for the electrocardiogram, cardiac compartmental volumes, and arterial vessel size in males and females for various age groups. These values may further depend on other variables such as body size, physical training status, and ethnicity. Additional variables relevant for cardiology such as those referring to the microcirculation and biomarkers are only mentioned with reference to the pertinent literature. In general, the sex- and age-specific differences observed are often remarkable and warrant consideration in clinical practice and basic biomedical sciences.


Cardiology Reference values Normal limits Nomogram Ejection fraction Cutoff values Heart rate Heart rate variability Electrocardiogram Pediatric cardiology Blood pressure Pulsology Ventricular size Right ventricle Left atrium Right atrium Aortic diameter Coronary artery Coronary-aorta index Biomarkers Surrogate index Tissue Doppler imaging Age-specific analysis Sex-specific analysis Aging effects Giovanni Borelli Review 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular SciencesVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Nuclear Medicine, Royal Victoria InfirmaryNewcastle upon TyneUK
  3. 3.Institute of Health and Wellbeing, Electrocardiology Group, University of GlasgowGlasgow, ScotlandUK

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