New perspectives in the assessment of cardiac chamber dimensions during development and adulthood

Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Boston 02114.

The use of body surface area to assess the normalcy of cardiac dimensions has several limitations. To determine whether cardiac dimensions can be assessed by other indexes of body size and growth, this study evaluated the relations between cardiac dimensions assessed by two-dimensional echocardiography and age, height, weight and body surface area. The study group included 268 normal persons aged 6 days to 76 years of age. The dimensions examined included the aortic anulus, left atrium and left ventricular end-diastolic diameter, each measured in the parasternal long-axis plane, and left ventricular length measured from the apical two-chamber view. The analysis confirmed that the heart and great vessels grow in unison and at a predictable rate after birth, reaching 50% of their adult dimensions at birth, 75% by 5 years and 90% by 12 years. Although each cardiac dimension related linearly with height (aortic anulus, r = 0.96; left atrium, r = 0.91; left ventricular diameter, r = 0.94; left ventricular length, r = 0.93), the relations among age, weight and body surface area were best expressed by quadratic equations. Multiple regression confirmed that after adjustment for height, other indexes including age, gender, weight and body surface area had no independent effect on the prediction of each dimension. Therefore, because height is a nonderived variable that relates linearly with cardiac dimensions independent of age, it offers a simple yet accurate means of assessing the normalcy of cardiac dimensions in children and adults.

This article has been cited by other articles:

				G. Nevsky, J. E. Jacobs, and M. B. Srichai Reply Am. J. Roentgenol., November 1, 2011; 197(5): W967 - W967. [Full Text] [PDF]

				N. Patel, M. Dodsworth, and J. F. Mills Cardiac output measurement in newborn infants using the ultrasonic cardiac output monitor: an assessment of agreement with conventional echocardiography, repeatability and new user experience Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2011; 96(3): F206 - F211. [Abstract] [Full Text] [PDF]

				A. Goncalves, P. Marcos-Alberca, P. Sogaard, and J. L. Zamorano Chapter 8 Assessment of systolic function The EAE Textbook of Echocardiography, March 1, 2011; 1(1): med-9780199599639-chapter - med-9780199599639-chapter. [Abstract] [Full Text]

				M. N. Awori, K. Finucane, and T. L. Gentles Optimal Normative Pediatric Cardiac Structure Dimensions for Clinical Use World Journal for Pediatric and Congenital Heart Surgery, January 1, 2011; 2(1): 85 - 89. [Abstract] [Full Text] [PDF]

				S. Meyer, D. Todd, and B. Shadboldt Non-invasive cardiac output monitoring in neonates Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2010; 95(6): F464 - F464. [Full Text] [PDF]

				J. M. Simpson, A. Savis, D. Rawlins, S. Qureshi, and M. D. Sinha Incidence of left ventricular hypertrophy in children with kidney disease: impact of method of indexation of left ventricular mass Eur Heart J Cardiovasc Imaging, April 1, 2010; 11(3): 271 - 277. [Abstract] [Full Text] [PDF]

				T. G. Neilan, A. D. Pradhan, M. E. King, and A. E. Weyman Derivation of a size-independent variable for scaling of cardiac dimensions in a normal paediatric population Eur Heart J Cardiovasc Imaging, January 1, 2009; 10(1): 50 - 55. [Abstract] [Full Text] [PDF]

				A. Evangelista, F. Flachskampf, P. Lancellotti, L. Badano, R. Aguilar, M. Monaghan, J. Zamorano, P. Nihoyannopoulos, and on behalf of the European Association of Echocardi European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies Eur Heart J Cardiovasc Imaging, July 1, 2008; 9(4): 438 - 448. [Abstract] [Full Text] [PDF]

				L. Siu, A. Tucker, S. K. Manikappa, and J. Monagle Does Patient Position Influence Doppler Signal Quality from the USCOM Ultrasonic Cardiac Output Monitor? Anesth. Analg., June 1, 2008; 106(6): 1798 - 1802. [Abstract] [Full Text] [PDF]

				B. A. Keller State of the Art Reviews: Development of Fitness in Children: The Influence of Gender and Physical Activity American Journal of Lifestyle Medicine, February 1, 2008; 2(1): 58 - 74. [Abstract] [PDF]

				Y. Notomi, G. Srinath, T. Shiota, M. G. Martin-Miklovic, L. Beachler, K. Howell, S. J. Oryszak, D. G. Deserranno, A. D. Freed, N. L. Greenberg, et al. Maturational and Adaptive Modulation of Left Ventricular Torsional Biomechanics: Doppler Tissue Imaging Observation From Infancy to Adulthood Circulation, May 30, 2006; 113(21): 2534 - 2541. [Abstract] [Full Text] [PDF]

				R. M. Lang, M. Bierig, R. B. Devereux, F. A. Flachskampf, E. Foster, P. A. Pellikka, M. H. Picard, M. J. Roman, J. Seward, J. Shanewise, et al. Recommendations for chamber quantification Eur Heart J Cardiovasc Imaging, March 1, 2006; 7(2): 79 - 108. [Abstract] [Full Text] [PDF]

				C. Amarelli, A. Della Corte, G. Romano, G. Iasevoli, G. Dialetto, L. S. De Santo, M. De Feo, M. Torella, M. Scardone, and M. Cotrufo Left ventricular mass regression after aortic valve replacement with 17-mm St Jude Medical mechanical prostheses in isolated aortic stenosis J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 512 - 517. [Abstract] [Full Text] [PDF]

				H. L. Tan, M. Pinder, R. Parsons, B. Roberts, and P. V. van Heerden Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit Br. J. Anaesth., March 1, 2005; 94(3): 287 - 291. [Abstract] [Full Text] [PDF]

				L. A. Critchley, Z. Y. Peng, B. S. Fok, A. Lee, and R. A. Phillips Testing the Reliability of a New Ultrasonic Cardiac Output Monitor, the USCOM, by Using Aortic Flowprobes in Anesthetized Dogs Anesth. Analg., March 1, 2005; 100(3): 748 - 753. [Abstract] [Full Text] [PDF]

				B. M. McQuillan, M. H. Picard, M. Leavitt, and A. E. Weyman Clinical Correlates and Reference Intervals for Pulmonary Artery Systolic Pressure Among Echocardiographically Normal Subjects Circulation, December 4, 2001; 104(23): 2797 - 2802. [Abstract] [Full Text] [PDF]

				M. Demir and E. Acarturk Clinical Characteristics Influence Aortic Root Dimension and Blood Flow Velocity in Healthy Subjects Angiology, July 1, 2001; 52(7): 457 - 461. [Abstract] [PDF]

				T. Rowland, D. Goff, L. Martel, and L. Ferrone Influence of Cardiac Functional Capacity on Gender Differences in Maximal Oxygen Uptake in Children Chest, March 1, 2000; 117(3): 629 - 635. [Abstract] [Full Text] [PDF]

				K. A. Crispell, A. Wray, H. Ni, D. J. Nauman, and R. E. Hershberger Clinical profiles of four large pedigrees with familial dilated cardiomyopathy: Preliminary recommendations for clinical practice J. Am. Coll. Cardiol., September 1, 1999; 34(3): 837 - 847. [Abstract] [Full Text] [PDF]

				R. S. Vasan, M. G. Larson, D. Levy, J. C. Evans, and E. J. Benjamin Distribution and Categorization of Echocardiographic Measurements in Relation to Reference Limits : The Framingham Heart Study: Formulation of a Height- and Sex-Specific Classification and Its Prospective Validation Circulation, September 16, 1997; 96(6): 1863 - 1873. [Abstract] [Full Text]

				R. S. Vasan, S. Shrivastava, M. Vijayakumar, R. Narang, B. C. Lister, and J. Narula Echocardiographic Evaluation of Patients With Acute Rheumatic Fever and Rheumatic Carditis Circulation, July 1, 1996; 94(1): 73 - 82. [Abstract] [Full Text]

				M. Kim, M. J. Roman, M. C. Cavallini, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Effect of Hypertension on Aortic Root Size and Prevalence of Aortic Regurgitation Hypertension, July 1, 1996; 28(1): 47 - 52. [Abstract] [Full Text]

				S. M. Vaziri, M. G. Larson, M. S. Lauer, E. J. Benjamin, and D. Levy Influence of Blood Pressure on Left Atrial Size : The Framingham Heart Study Hypertension, June 1, 1995; 25(6): 1155 - 1160. [Abstract] [Full Text]

				R. S. Vasan, M. G. Larson, and D. Levy Determinants of Echocardiographic Aortic Root Size : The Framingham Heart Study Circulation, February 1, 1995; 91(3): 734 - 740. [Abstract] [Full Text]