CLINICAL STUDY: LEFT VENTRICULAR FUNCTION
Gender differences and normal left ventricular anatomy in an adult population free of hypertension
A cardiovascular magnetic resonance study of the Framingham Heart Study Offspring cohort
Carol J. Salton, BA*,
Michael L. Chuang, ScM*,
Christopher J. O’Donnell, MD, MPH, FACC  ,
Michelle J. Kupka, MA,
Martin G. Larson, ScD,
Kraig V. Kissinger, BS, RT, (MR) (R)*,
Robert R. Edelman, MD ,
Daniel Levy, MD, FACC* and
Warren J. Manning, MD, FACC*,*
* Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Department of Medicine, Boston, Massachusetts, USA
Department of Radiology, Beth Israel Deaconess Medical Center; Department of Medicine, Boston, Massachusetts, USA
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
NHLBI’s Framingham Heart Study, Framingham, Massachusetts, USA
Manuscript received July 11, 2001;
revised manuscript received November 12, 2001,
accepted December 19, 2001.
* Reprint requests and correspondence: Dr. Warren J. Manning, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA.
wmanning{at}caregroup.harvard.edu
OBJECTIVES: We sought to derive gender-specific cardiovascular magnetic resonance (CMR) reference values for normative left ventricular (LV) anatomy and function in a healthy adult population of clinically relevant age.
BACKGROUND: Cardiovascular magnetic resonance imaging is increasingly applied in the clinical setting, but age-relevant, gender-specific normative values are currently unavailable.
METHODS: A representative sample of 318 Framingham Heart Study (FHS) Offspring participants free of clinically overt cardiovascular disease underwent CMR examination to determine LV end-diastolic and end-systolic volume (EDV and ESV, respectively), mass, ejection fraction (EF) and linear dimensions (wall thickness, cavity length). Subjects with a clinical history of hypertension or those with a systolic blood pressure  140 mm Hg or diastolic pressure 90 mm Hg at any FHS cycle examination were excluded, leaving 142 subjects (63 men, 79 women; age 57 ± 9 years).
RESULTS: All volumetric (EDV, ESV, mass) and unidimensional measures were significantly greater (p < 0.001) in men than in women and remained greater (p < 0.02) after adjustment for subject height. Volumetric measures were greater (p < 0.001) in men than in women after adjustment for body surface area (BSA), but there were increased linear dimensions in women after adjustment for BSA. In particular, end-diastolic dimension indexed to BSA was greater in women (p < 0.001) than in men. There were no gender differences in global LVEF (men = 0.69; women = 0.70).
CONCLUSIONS: Cardiovascular magnetic resonance measures of LV volumes, mass and linear dimensions differ significantly according to gender and body size. This study provides gender-specific normal CMR reference values, uniquely derived from a population-based sample of persons free of cardiovascular disease and clinical hypertension. These data may serve as a reference to identify LV pathology in the adult population.
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Abbreviations and Acronyms
| | BMI | | BMI | | body mass index | | BSA | | body surface area | | CMR | | cardiovascular magnetic resonance | | ECG | | electrocardiogram | | EDD | | end-diastolic dimension | | EDV | | end-diastolic volume | | EF | | ejection fraction | | ESV | | end-systolic volume | | FHS | | Framingham Heart Study | | IVS | | interventricular septum thickness | | LV | | left ventricular | | PWT | | posterior wall thickness |
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