Reference Values for Real Time Three-Dimensional Echocardiography-Derived Left Ventricular Volumes and Ejection Fraction: Review and Meta-Analysis of Currently Available Studies

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 32; no. 12; pp. 1841 - 1850
• Main Authors: Buccheri, Sergio, Costanzo, Luca, Tamburino, Corrado, Monte, Ines
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.12.2015
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aging - physiology; Body Size - physiology; Computer Systems; Echocardiography, Three-Dimensional - standards; Echocardiography, Three-Dimensional - statistics & numerical data; Female; Heart Ventricles - diagnostic imaging; Humans; Image Interpretation, Computer-Assisted - standards; left ventricular volumes; Male; Middle Aged; Practice Guidelines as Topic; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Sex Factors; Stroke Volume - physiology; three-dimensional echocardiography; Ventricular Function, Left - physiology; Young Adult; three-dimensional echocardiography; left ventricular volumes
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.12972

Introduction Current guidelines recommend three‐dimensional echocardiography (3DE) as the reference technique to assess left ventricular (LV) volumes and ejection fraction (EF). We performed a meta‐analysis to identify normative reference values by real time 3DE in healthy subjects. Methods We searched MEDLINE and the Cochrane Library databases using the key search terms three‐dimensional echocardiography, volumes, and healthy. Data were pooled using random‐effects meta‐analysis, and source of variation was investigated using meta‐regression. After selection, 13 articles were included (2806 subjects). Four studies were conducted in children and young adolescents; one study provided data in an independent pediatric subgroup. Results In adults, pooled mean value for LV EDV was 98.4 mL (95%CI, 87–110 mL), while LV ESV mean value was 37.0 mL (95%CI, 32–42 mL). LV EF mean value was 62.9% (95%CI 61.7–64.2%). Male subjects showed a significant increase in both LV EDV index (mean difference 5.3 mL/m2; P < 0.001) and LV ESV index (mean difference 3.3 mL/m2; P < 0.001). LV EF was significantly higher in female subjects (P = 0.003). In pediatric studies, LV EDV pooled mean value was 53.1 mL (95%CI, 38.1–68 mL), while for LV ESV, it was 19.8 mL (95%CI, 14.8–24.8 mL); LV EF mean value was 63.3% (95%CI, 61.6–65%). Significant heterogeneity and inconsistency were noted among studies. Age, systolic blood pressure, and heart rate were identified as a source of between‐studies variation for LV volumes. Body surface area was a predictor of nonindexed LV volumes. Conclusions Data from available studies of normative values for 3DE were summarized. Our findings may increase the generalizability of LV normative data by 3DE.