Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight

Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.

OBJECTIVES. This study was designed to determine the most appropriate method to normalize left ventricular mass for body size. BACKGROUND. Left ventricular mass has been normalized for body weight, surface area or height in experimental and clinical studies, but it is uncertain which of these approaches is most appropriate. METHODS. Three normotensive population samples--in New York City (127 adults), Naples, Italy (114 adults) and Cincinnati, Ohio (444 infants to young adults)--were studied by echocardiography. Relations of left ventricular mass to body size were similar in all normal weight groups, as assessed by linear and nonlinear regression analysis, and results were pooled (n = 611). RESULTS. Left ventricular mass was related to body weight to the first power (r = 0.88), to body surface area to the 1.5 power (r = 0.88) and to height to the 2.7 power (r = 0.84), consistent with expected allometric (growth) relations between variables with linear (height), second-power (body surface area) and volumetric (left ventricular mass and body weight) dimensions. Strong residual relations of left ventricular mass/body surface area to body surface area (r = 0.54) and of ventricular mass/height to height (r = 0.72) were markedly reduced by normalization of ventricular mass for height2.7 and body surface area1.5. The variability among subjects of ventricular mass was also reduced (p < 0.01 to p < 0.002) by normalization for body weight, body surface area, body surface area1.5 or height2.7 but not for height. In 20% of adults who were overweight, ventricular mass was 14% higher (p < 0.001) than ideal mass predicted from observed height and ideal weight; this increase was identified as 14% by left ventricular mass/height2.7 and 9% by ventricular mass/height, whereas indexation for body surface area, body surface area1.5 and body weight erroneously identified left ventricular mass as reduced in overweight adults. CONCLUSIONS. Normalizations of left ventricular mass for height or body surface area introduce artifactual relations of indexed ventricular mass to body size and errors in estimating the impact of overweight. These problems are avoided and variability among normal subjects is reduced by using left ventricular mass/height2.7. Simple nomograms of the normal relation between height and left ventricular mass allow detection of ventricular hypertrophy in children and adults.

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				G. de Simone, D. W. Kitzman, M. Chinali, A. Oberman, P. N. Hopkins, D. C. Rao, D. K. Arnett, and R. B. Devereux Left ventricular concentric geometry is associated with impaired relaxation in hypertension: the HyperGEN study Eur. Heart J., May 2, 2005; 26(10): 1039 - 1045. [Abstract] [Full Text] [PDF]

				G. de Simone, M. J. Roman, M. H. Alderman, M. Galderisi, O. de Divitiis, and R. B. Devereux Is High Pulse Pressure a Marker of Preclinical Cardiovascular Disease? Hypertension, April 1, 2005; 45(4): 575 - 579. [Abstract] [Full Text] [PDF]

				N. Glorioso, F. Filigheddu, P. P. Parpaglia, A. Soro, C. Troffa, G. Argiolas, and P. Mulatero 11{beta}-Hydroxysteroid dehydrogenase type 2 activity is associated with left ventricular mass in essential hypertension Eur. Heart J., March 1, 2005; 26(5): 498 - 504. [Abstract] [Full Text] [PDF]

				M Zadinello, G Greve, X Q Liu, J R Barbosa Jr, I Schulze-Neick, J L Wilkinson, and A N Redington Angiotensin I converting enzyme genotype affects ventricular remodelling in children with aortic coarctation Heart, March 1, 2005; 91(3): 367 - 368. [Full Text] [PDF]

				M. Ries, S. Gupta, D. F. Moore, V. Sachdev, J. M. Quirk, G. J. Murray, D. R. Rosing, C. Robinson, E. Schaefer, A. Gal, et al. Pediatric Fabry Disease Pediatrics, March 1, 2005; 115(3): e344 - e355. [Abstract] [Full Text] [PDF]

				P. Verdecchia, F. Angeli, R. Gattobigio, M. Sardone, and C. Porcellati Asymptomatic Left Ventricular Systolic Dysfunction in Essential Hypertension: Prevalence, Determinants, and Prognostic Value Hypertension, March 1, 2005; 45(3): 412 - 418. [Abstract] [Full Text] [PDF]

				J. L. Olivares, M. Vazquez, G. Rodriguez, P. Samper, and J. Fleta Electrocardiographic and Echocardiographic Findings in Malnourished Children J. Am. Coll. Nutr., February 1, 2005; 24(1): 38 - 43. [Abstract] [Full Text] [PDF]

				G. de Simone, S. R. Daniels, T. R. Kimball, M. J. Roman, C. Romano, M. Chinali, M. Galderisi, and R. B. Devereux Evaluation of Concentric Left Ventricular Geometry in Humans: Evidence for Age-Related Systematic Underestimation Hypertension, January 1, 2005; 45(1): 64 - 68. [Abstract] [Full Text] [PDF]

				E. Nunez, D. K. Arnett, E. J. Benjamin, P. R. Liebson, T. N. Skelton, H. Taylor, and M. Andrew Optimal Threshold Value for Left Ventricular Hypertrophy in Blacks: The Atherosclerosis Risk in Communities Study Hypertension, January 1, 2005; 45(1): 58 - 63. [Abstract] [Full Text] [PDF]

				A. D. Waggoner Echocardiographic Assessment of Left Ventricular Structure in Hypertension and the Impact on Clinical Outcomes Journal of Diagnostic Medical Sonography, September 1, 2004; 20(5): 304 - 314. [Abstract] [PDF]

				G. A. Whalley, R. N. Doughty, G. D. Gamble, H. C. Oxenham, H. J. Walsh, I. R. Reid, and J. C. Baldi Association of fat-free mass and training status with left ventricular size and mass in endurance-trained athletes J. Am. Coll. Cardiol., August 18, 2004; 44(4): 892 - 896. [Abstract] [Full Text] [PDF]

				F. Orio Jr., S. Palomba, L. Spinelli, T. Cascella, L. Tauchmanova, F. Zullo, G. Lombardi, and A. Colao The Cardiovascular Risk of Young Women with Polycystic Ovary Syndrome: An Observational, Analytical, Prospective Case-Control Study J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3696 - 3701. [Abstract] [Full Text] [PDF]

				National High Blood Pressure Education Program Wor The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents Pediatrics, August 1, 2004; 114(2/S2): 555 - 576. [Full Text] [PDF]

				E. Fox, H. Taylor, M. Andrew, H. Han, E. Mohamed, R. Garrison, and T. Skelton Body Mass Index and Blood Pressure Influences on Left Ventricular Mass and Geometry in African Americans: The Atherosclerotic Risk In Communities (ARIC) Study Hypertension, July 1, 2004; 44(1): 55 - 60. [Abstract] [Full Text] [PDF]

				M. Klapholz, M. Maurer, A. M. Lowe, F. Messineo, J. S. Meisner, J. Mitchell, J. Kalman, R. A. Phillips, R. Steingart, E. J. Brown Jr, et al. Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: Results of the New York heart failure registry J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1432 - 1438. [Abstract] [Full Text] [PDF]

				G. de Simone Concentric or Eccentric Hypertrophy: How Clinically Relevant Is the Difference? Hypertension, April 1, 2004; 43(4): 714 - 715. [Full Text] [PDF]

				C. J. Rodriguez, R. R. Sciacca, A. V. Diez-Roux, B. Boden-Albala, R. L. Sacco, S. Homma, and M. R. DiTullio Relation Between Socioeconomic Status, Race-Ethnicity, and Left Ventricular Mass: The Northern Manhattan Study Hypertension, April 1, 2004; 43(4): 775 - 779. [Abstract] [Full Text] [PDF]

				J. M. Sorof, J. Turner, D. S. Martin, K. Garcia, Z. Garami, A. V. Alexandrov, F. Wan, and R. J. Portman Cardiovascular Risk Factors and Sequelae in Hypertensive Children Identified by Referral Versus School-Based Screening Hypertension, February 1, 2004; 43(2): 214 - 218. [Abstract] [Full Text] [PDF]