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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

  • Cardiac
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A Correction to this article was published on 19 April 2018

This article has been updated

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.

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Change history

  • 19 April 2018

    The original version of this article, published on 14 March 2018, unfortunately contained a mistake.

Abbreviations

ATC:

Anatomical therapeutic chemical

BSA :

Body surface area

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

ECG:

Electrocardiogram

LGE:

Late gadolinium enhancement

LV:

Left ventricular

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end-systolic volume

LVMM:

Left ventricular myocardial mass

LVSV:

Left ventricular stroke volume

MR:

Magnetic resonance

SD:

Standard deviation

SHIP:

Study of Health in Pomerania

SSFP:

Steady-state free precession

TE:

Echo time

TR:

Repetition time

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Funding

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).

Author information

Authors and Affiliations

  1. Institute for Diagnostic Radiology and Neuroradiology, University Medicine, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany

    Robin Bülow, Sönke Langner & Norbert Hosten

  2. Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine, Ernst Moritz Arndt University Greifswald, Walther Rathenau Str. 48, 17475, Greifswald, Germany

    Till Ittermann & Henry Völzke

  3. Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine, Ernst Moritz Arndt University, Ferdinand-Sauerbruch-Straße 1, 17475, Greifswald, Germany

    Marcus Dörr & Axel Poesch

  4. DZHK (German Centre for Cardiovascular Research), Greifswald, Germany

    Marcus Dörr & Henry Völzke

  5. Institute for Radiology, Charité Medical School, Charitéplatz 1, 10117, Berlin, Germany

    Marc Dewey

Authors
  1. Robin Bülow
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  2. Till Ittermann
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  3. Marcus Dörr
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  4. Axel Poesch
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  5. Sönke Langner
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  6. Henry Völzke
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  7. Norbert Hosten
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  8. Marc Dewey
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Corresponding author

Correspondence to Robin Bülow.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Robin Bülow, MD (buelowr@uni-greifswald.de).

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.

Methodology

• retrospective

• cross-sectional study/observational

• performed at one institution

Additional information

The original version of this article was revised: The sequence of the author names was incorrect, Robin Bülow was mentioned twice.

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Bülow, R., Ittermann, T., Dörr, M. et al. 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. Eur Radiol 28, 3996–4005 (2018). https://doi.org/10.1007/s00330-018-5345-y

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