Application of Allometric Methods for Indexation of Left Ventricular End-Diastolic Volume to Normal Echocardiographic Data and Assessing Gender and Racial Differences

• Published in: Journal of the American Society of Echocardiography Vol. 36; no. 6; pp. 596 - 603.e3
• Main Authors: Nabeshima, Yosuke, Addetia, Karima, Asch, Federico M., Lang, Roberto M., Takeuchi, Masaaki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2023; Elsevier BV
• Subjects: Allometric method; Brazil; Cardiovascular; Echocardiography; Echocardiography - methods; Female; Heart Ventricles; Heart Ventricles - diagnostic imaging; Humans; Male; Race Factors; Racial difference; Reference Values; Stroke Volume; Three-dimensional echocardiography; Brazil; BSA; ELBM; WASE; LBM; Three-dimensional echocardiography; LV; LVEDV; Allometric method; Racial difference; Left ventricular; World Alliance Societies of Echocardiography; Lean body mass; Body surface area; Estimated lean body mass; Left ventricular end-diastolic volume
• ISSN: 0894-7317; 1097-6795; 1097-6795
• DOI: 10.1016/j.echo.2023.02.004

Gender and racial differences in cardiac chamber size are vital to establish normal ranges of cardiac chamber size in healthy subjects. Many studies report either nonindexed raw measurements or measurements indexed to isometric body surface area (BSA) when establishing normal reference values. Other studies advocate allometric indexation for standardization of heart size. We compared several allometric methods on gender and racial differences in left ventricular end-diastolic volume (LVEDV) measured on three-dimensional echocardiography. Three-dimensional echocardiographic LVEDV data from the World Alliance Societies of Echocardiography normal values study were indexed to isometric BSA, BSA1.5, BSA1.8, isometric height, height2.3, height2.9, and estimated lean body mass. Gender, racial, national, and regional differences in indexed and nonindexed LVEDV were assessed using Cohen’s d statistic or Cohen’s f statistic, according to the number of groups being compared. Cohen’s d < 0.20 and Cohen’s f < 0.10 were regarded as very small relative magnitudes of difference. Differences in LVEDV among White, Black, and Asian races were smallest when BSA1.5 or BSA1.8 was used for indexation, followed by estimated lean body mass. LVEDV/BSA1.5 was nearly identical for men and women (very small, d = 0.05). However, both LVEDV/BSA1.5 and LVEDV/BSA1.8 still provided moderate relative magnitudes of difference (f = 0.22–0.37) among geographic regions. Specifically, among Asians, Indians had the smallest LVEDV/BSA1.5 (1.8). Brazilians had the smallest LVEDV/BSA1.5 (1.8) among Whites. Gender and racial differences in LVEDV became smaller when LVEDV was indexed to BSA1.5 or BSA1.8. However, differences in LVEDV among nations remain even after applying allometric scaling. This finding suggests that differences in body composition and/or hemodynamics are potentially more important determinants of heart size than race or gender. •LVEDV/BSA1.5 and LVEDV/BSA1.8 yielded small Cohen’s d between genders.•LVEDV/BSA1.5 and LVEDV/BSA1.8 provided small Cohen’s f among nationalities.•All indexation methods showed small but persistent differences in LVEDV.•LVEDV was normalized across gender and race to a greater degree than nationality.