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Reference values for left ventricular dimensions, systolic and diastolic function: a study from the Amazon Basin of Brazil

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Abstract

Country- and ethnicity-specific reference values for echocardiographic parameters are necessary for decision making. No prior studies have examined reference values in adults from the Amazon Basin of Brazil. We performed echocardiographic examinations in 290 healthy adults (mean age 37 ± 14 years, 40% male) from the Brazilian Amazon. Left ventricular (LV) dimensions and volumes were obtained and indexed to body surface area. We also assessed systolic (LV ejection fraction [LVEF] and global longitudinal strain [GLS]) and diastolic function. LV dimensions and volumes were larger in males compared to females, but after indexation only volumes remained larger (P < 0.001 for all). Parameters of systolic function, were significantly greater in females (LVEF 50 to 68%, GLS − 17 to − 24%) than in males (LVEF 50 to 67%, GLS − 15 to − 23%, P < 0.05). Upper limits of normality for cardiac dimensions (indexed and non-indexed) were markedly higher compared to contemporary guidelines (American Society of Echocardiography) and the Brazilian subgroup in the World Alliance Society of Echocardiography (WASE). Lower limit of normality for LVEF (both sex 50%) and upper limit of normality for the left atrial volume index (LAVI) (male: 31 mL/m2, female: 25 mL/m2) were within normal range but slightly lower compared to guidelines and the WASE study. Other diastolic parameters, including E/A-ratio, E/e’ ratio and peak tricuspid regurgitation velocity were compatible with present recommendations. Normal reference ranges of echocardiographic parameters in healthy adults from the Brazilian Amazon Basin may be different compared to international guidelines and data from other regions of Brazil. This applies specifically for LVEF and LAVI.

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References

  1. Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003

    Article  PubMed  Google Scholar 

  2. Friedman GD, Cutter GR, Donahue RP et al (1988) Cardia: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol 41:1105–1116. https://doi.org/10.1016/0895-4356(88)90080-7

    Article  CAS  PubMed  Google Scholar 

  3. Kou S, Caballero L, Dulgheru R et al (2014) Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Hear J Cardiovasc Imaging 15:680–690. https://doi.org/10.1093/ehjci/jet284

    Article  Google Scholar 

  4. Asch FM, Miyoshi T, Addetia K et al (2019) Similarities and differences in left ventricular size and function among races and nationalities: results of the world alliance societies of echocardiography normal values study. J Am Soc Echocardiogr 32:1396-1406.e2. https://doi.org/10.1016/j.echo.2019.08.012

    Article  PubMed  Google Scholar 

  5. Miyoshi T, Addetia K, Citro R et al (2020) Left ventricular diastolic function in healthy adult individuals: results of the world alliance societies of echocardiography normal values study. J Am Soc Echocardiogr 33:1223–1233. https://doi.org/10.1016/j.echo.2020.06.008

    Article  PubMed  Google Scholar 

  6. Ângelo LCS, Vieira MLC, Rodrigues SL et al (2007) Echocardiographic reference values in a sample of asymptomatic adult Brazilian population. Arq Bras Cardiol 89:184–190. https://doi.org/10.1590/S0066-782X2007001500007

    Article  Google Scholar 

  7. Schvartzman PR, Fuchs FD, Mello AG et al (2000) Normal values of echocardiographic measurements. A population-based study. Arq Bras Cardiol 75:111–114. https://doi.org/10.1590/S0066-782X2000000800003

    Article  Google Scholar 

  8. Rodrigues-Soares F, Kehdy FSG, Sampaio-Coelho J et al (2018) Genetic structure of pharmacogenetic biomarkers in Brazil inferred from a systematic review and population-based cohorts: a RIBEF/EPIGEN-Brazil initiative. Pharmacogenomics J 18:749–759. https://doi.org/10.1038/s41397-018-0015-7

    Article  CAS  PubMed  Google Scholar 

  9. Poppe KK, Doughty RN, Gardin JM et al (2015) Ethnic-specific normative reference values for echocardiographic LA and LV Size, LV Mass, and systolic function: the EchoNoRMAL study. JACC Cardiovasc Imaging 8:656–665. https://doi.org/10.1016/j.jcmg.2015.02.014

    Article  Google Scholar 

  10. Marinho F, de Azeredo Passos VM, Carvalho Malta D et al (2018) Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. Lancet 392:760–775. https://doi.org/10.1016/S0140-6736(18)31221-2

    Article  Google Scholar 

  11. Garnelo L, Parente RCP, Puchiarelli MLR et al (2020) Barriers to access and organization of primary health care services for rural riverside populations in the Amazon. Int J Equity Health 19:1–14. https://doi.org/10.1186/s12939-020-01171-x

    Article  Google Scholar 

  12. Paim J, Travassos C, Almeida C et al (2011) The Brazilian health system: History, advances, and challenges. Lancet 377:1778–1797. https://doi.org/10.1016/S0140-6736(11)60054-8

    Article  PubMed  Google Scholar 

  13. Williams B, Mancia G, Spiering W et al (2018) 2018 practice guidelines for the management of arterial hypertension of the European society of cardiology and the European society of hypertension ESC/ESH task force for the management of arterial hypertension

  14. American-Diabetes-Association (2020) 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes - 2020. Diabetes Care 43:S14–S31. https://doi.org/10.2337/dc20-S002

    Article  Google Scholar 

  15. Reméanyi B, Wilson N, Steer A et al (2012) World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nat Rev Cardiol 9:297–309. https://doi.org/10.1038/nrcardio.2012.7

    Article  Google Scholar 

  16. Lang RM, Badano LP, Victor MA et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Hear J Cardiovasc Imaging 16:233–271. https://doi.org/10.1016/j.echo.2014.10.003

    Article  Google Scholar 

  17. Voigt JU, Pedrizzetti G, Lysyansky P et al (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 16:1–11. https://doi.org/10.1093/ehjci/jeu184

    Article  CAS  PubMed  Google Scholar 

  18. Cheng S, Larson MG, McCabe EL et al (2013) Age- and sex-based reference limits and clinical correlates of myocardial strain and synchrony: the framingham heart study. Circ Cardiovasc Imaging 6:692–699. https://doi.org/10.1161/CIRCIMAGING.112.000627

    Article  PubMed  Google Scholar 

  19. Brainin P, Biering-Sørensen SR, Møgelvang R et al (2018) Post-systolic shortening: normal values and association with validated echocardiographic and invasive measures of cardiac function. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-018-1474-2

    Article  PubMed  Google Scholar 

  20. Natori S, Lai S, Finn JP et al (2006) Cardiovascular function in multi-ethnic study of atherosclerosis: Normal values by age, sex, and ethnicity. Am J Roentgenol. https://doi.org/10.2214/AJR.04.1868

    Article  Google Scholar 

  21. Lang RM, Badano LP, Mor-Avi V et al (2015) afbeelding 5. J Am Soc Echocardiogr 28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003

    Article  PubMed  Google Scholar 

  22. Russo C, Jin Z, Homma S et al (2015) Race-ethnic differences in subclinical left ventricular systolic dysfunction by global longitudinal strain: a community-based cohort study. Am Heart J 169:721–726. https://doi.org/10.1016/j.ahj.2015.02.011

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fernandes-Silva MM, Shah AM, Hegde S et al (2017) Race-related differences in left ventricular structural and functional remodeling in response to increased afterload: the ARIC study. JACC Hear Fail 5:157–165. https://doi.org/10.1016/j.jchf.2016.10.011

    Article  Google Scholar 

  24. Daimon M, Watanabe H, Abe Y et al (2008) Normal values of echocardiographic parameters in relation to age in a healthy Japanese population: the JAMP study. Circ J 72:1859–1866. https://doi.org/10.1253/circj.CJ-08-0171

    Article  PubMed  Google Scholar 

  25. Caballero L, Kou S, Dulgheru R et al (2015) Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE study. Eur Hear J Cardiovasc Imaging 18:1031–1041. https://doi.org/10.1093/ehjci/jev083

    Article  Google Scholar 

  26. Farsalinos KE, Daraban AM, Ünlü S et al (2015) Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE inter-vendor comparison study. J Am Soc Echocardiogr 28:1171-1181.e2. https://doi.org/10.1016/j.echo.2015.06.011

    Article  PubMed  Google Scholar 

  27. Ribeiro ALP, Duncan BB, Brant LCC et al (2016) Cardiovascular health in Brazil trends and perspectives. Circulation 133:422–433. https://doi.org/10.1161/CIRCULATIONAHA.114.008727

    Article  PubMed  Google Scholar 

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Acknowledgements

We are thankful for the collaboration of the Health Department of the State of Acre (SESACRE), the Municipal Health Department of Cruzeiro do Sul, Acre (SMS) and for the help and guidance of Suiane da Costa Negreiros do Valle, MD, PhD and Janaína Alencar, MD, and all the employees in healthcare clinics in Cruzeiro do Sul, Acre.

Funding

Funding specifically rewarded for ‘The Malaria Heart Study’: PB and AEH: Jette and Hans Henrik Jensen, The Independent Research Fund Denmark (0129-0003B), Dansk Medicinsk Selskab København (120620-kms), Julie von Müllens Fond, Knud Højgaards Fond (18-05-2487), A. P. Møllers Lægefond (18-L-0026), Reinholdt W. Jorck og Hustrus Fond (18-JU-0485), Eva og Henry Frænkels Mindefond (NLA-080919), Astra Zeneca/Danish Society of Cardiology, Internal Funds at Herlev-Gentofte Hospital, Torben og Alice Frimodts Fond (TA250419), Brorsons Fond (12038-1-hh), Lundbeckfonden (R373-2021–1201). AW: Danish Heart Association (20-R139-A9644-22165), William Demant (20–1257), Knud Højgaards Fond (20–01-1076), Reinholdt W. Jorck og Hustrus Fond (20-JU-0145). MK: Novo Nordisk Fonden (NNF20OC0062782). LCG: CNPq (142306/2020–7). Other sources of funding not dedicated to ‘The Malaria Heart Study’: CRFM: FAPESP (2020/06747–4) and CNPq (302917/2019–5). LOM, KOL, IVMV, RMS, FJO, TBS and OMS provided no financial support for the study. No sponsors had any role in the design, conduction or analysis of the study.

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Author notes

  1. Alma Wegener and Molly D. Kaagaard have contributed equally to this study.

Authors and Affiliations

  1. Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil

    Alma Wegener, Molly D. Kaagaard, Anna Engell Holm, Luan O. Matos, Karine O. Lima, Isabelle V. M. Vieira, Rodrigo Medeiros de Souza & Philip Brainin

  2. Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark

    Alma Wegener, Molly D. Kaagaard, Anna Engell Holm, Flemming Javier Olsen, Tor Biering-Sørensen & Philip Brainin

  3. Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil

    Laura Cordeiro Gomes & Claudio Romero Farias Marinho

  4. Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark

    Tor Biering-Sørensen

  5. Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil

    Odilson M. Silvestre

Authors
  1. Alma Wegener
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  2. Molly D. Kaagaard
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  3. Laura Cordeiro Gomes
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  7. Isabelle V. M. Vieira
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  13. Philip Brainin
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Corresponding author

Correspondence to Philip Brainin.

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The study received approval from the institutional review board, all participants provided written informed consent and the study complies with the Helsinki declaration. All authors have approved of the present manuscript.

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Wegener, A., Kaagaard, M.D., Gomes, L.C. et al. Reference values for left ventricular dimensions, systolic and diastolic function: a study from the Amazon Basin of Brazil. Int J Cardiovasc Imaging 38, 813–822 (2022). https://doi.org/10.1007/s10554-021-02475-x

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  • DOI: https://doi.org/10.1007/s10554-021-02475-x

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