Ethnic-Specific Normative References in Echocardiography | Journal Scan

Study Questions:

What are age-, sex-, and ethnic-based reference values for left atrial (LA) and left ventricular (LV) dimensions and volumes, LV mass, fractional shortening, and ejection fraction (EF)?


The data were derived from a meta-analysis of 22,404 adults without known clinical cardiovascular disease, renal disease, hypertension, or diabetes in an individual person meta-analysis reported from 43 studies. Upper and lower reference values (URVs, LRVs) were defined as the 95th and 5th percentile of each measurement stratified by age, sex, and ethnic group.


Data sufficient to develop reference values were available for each sex in the five largest ethnic groups (European, East Asian, South Asian, American Black, African). After indexing by body surface area or height, sex and ethnic differences remained for left ventricular end-diastolic volume (LVEDV), LV end-systolic volume (LVSV), and LV stroke volume (SV) with highest volumes in Europeans and lowest in South Asians. A decrease in LVEDV and LVESV was noted with increasing age in all ethnic groups. The LRV for EF varied by ethnicity; the greatest difference apparent between Europeans and Asians. The URV for LVEDD and LVESD was higher for Europeans than for East Asian, South Asian, and African populations. This difference was most prominent in men. The URV for LA diameter and volume was highest for Europeans.


Echocardiographic normative reference values vary with sex and ethnicity. Reference values for LV volume and mass vary with age. Future echocardiographic studies of normal and disease states should take into account not only age, gender, and body size, but also ethnicity.


Multiple studies have attempted to define the normal range for various echocardiographic parameters including linear and volume-based measurements. Single studies have often concentrated on one ethnic group. This large meta-analysis of over 22,000 apparently disease-free adults provides further valuable information confirming the obvious relationship of cardiac chamber measurements to body size, but also extends it in a robust manner to age and ethnicity. These normative values should be taken into account both for defining clinical abnormalities and obviously for investigation of disease and therapeutic effects. Failure to recognize the variability in measurement based on these parameters potentially would result in either over- or underdiagnosis of disease states.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Echocardiography/Ultrasound

Keywords: Body Size, Body Surface Area, Diagnostic Imaging, Diastole, Echocardiography, Ethnic Groups, Reference Values, Stroke Volume, Systole

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