Top reasons for this website:
The definition of abnormal relies on the definition of normal.
There are a number of controversies surrounding the measurement of LVM.
Not only is there controversy regarding the measurement of LVM, but particularly around the definition of "LVH". So much so it almost makes one wonder about it as an important marker of disease: How can we be sure that LVH is bad if we can't even agree on what it is?
My particular interest in LVM and LVH is in the context of pediatric echocardiography; much of what is presented here is intended for others with similar interests. I have included some reference values for adults (mostly LVMi data) since not all of the patients that come through the pediatric echo lab are actual babies.
Scaling
I could go on and on about how we don't always get the scaling issue correct, but I could never say it as elegantly as these people do:
... theoretical arguments and empirical evidence indicate that indiscriminate use of ratiometric scaling approaches is at best problematic and at worst dangerous.
Moreover,
Because the cardiovascular system has evolved for efficient distribution of metabolic substrates (in particular, oxygen) to tissues with great potential for use of such substrates, the most appropriate scaling might be found in normalizing the circulatory supply (cardiovascular system) to the metabolically active tissue.
LBM is likely the best scaling variable and may be estimated reasonably accurately in children aged 5 to 21 years. Only by scaling LV mass to LBM will we be able to determine the impact of obesity on heart size.
What is presented on this website are LV mass z-scores adusted for lean body mass, and a few other calculations that wish they were LVM-for-LBM z-scores. I also include z-scores for the measured m-mode components of LV mass calculations (I find it fascinating that some patients will have LV mass values that are abnormal yet have completely normal dimensions otherwise). Also presented are calculations of, and reference values for, relative wall thickness and mass-for-volume ratio. Lastly, a few hypothetical situations are explored as suggested by various authors and thoughtful, pragmatic clinicians.
References
- New Reference Centiles for Left Ventricular Mass Relative to Lean Body Mass in Children.
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Foster BJ, Khoury PR, Kimball TR, Mackie AS, Mitsnefes M.
J Am Soc Echocardiogr. 2016 Feb 3. pii: S0894-7317(15)00966-9. - Left Ventricular Mass Indexing in Infants, Children, and Adolescents: A Simplified Approach for the Identification of Left Ventricular Hypertrophy in Clinical Practice.
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Chinali M, Emma F, Esposito C, Rinelli G, Franceschini A, Doyon A, Raimondi F, Pongiglione G, Schaefer F, Matteucci MC.
J Pediatr. 2015 Dec 6. pii: S0022-3476(15)01324-4. - Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE).
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Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M, Gottdiener J, Haluska B, Ofili E, Segers P, Senior R, Tapp RJ, Zamorano JL.
J Am Soc Echocardiogr. 2015 Jul;28(7):727-54. - Ethnic-Specific Normative Reference Values for Echocardiographic LA and LV Size, LV Mass, and Systolic Function: The EchoNoRMAL Study.
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Poppe KK, Doughty RN, Gardin JM, Hobbs FD, McMurray JJ, Nagueh SF, ... Salvetti M.
JACC Cardiovasc Imaging. 2015 Jun;8(6):656-65. - Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study.
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Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Gomez De Diego JJ, Hagendorff A, Henri C, Hristova K, Lopez T, Magne J, De La Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, Salustri A, Van De Veire N, Von Bardeleben RS, Vinereanu D, Voigt JU, Zamorano JL, Donal E, Lang RM, Badano LP, Lancellotti P.
Eur Heart J Cardiovasc Imaging. 2014 Jun;15(6):680-90. - Normal reference ranges for echocardiography: do we really need more?
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Lancellotti P.
Eur Heart J Cardiovasc Imaging. 2014 Mar;15(3):253-4. - Echocardiographic nomograms for ventricular, valvular and arterial dimensions in caucasian children with a special focus on neonates, infants and toddlers.
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Cantinotti M, Scalese M, Murzi B, Assanta N, Spadoni I, Festa P, De Lucia V, Crocetti M, Marotta M, Molinaro S, Lopez L, Iervasi G.
J Am Soc Echocardiogr. 2014 Feb;27(2):179-191. - Size matters! Impact of age, sex, height, and weight on the normal heart size.
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Pfaffenberger S, Bartko P, Graf A, Pernicka E, Babayev J, Lolic E, Bonderman D, Baumgartner H, Maurer G, Mascherbauer J.
Circ Cardiovasc Imaging. 2013 Nov;6(6):1073-9. - Limitations of expressing left ventricular mass relative to height and to body surface area in children.
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Foster BJ, Gao T, Mackie AS, Zemel BS, Ali H, Platt RW, Colan SD.
J Am Soc Echocardiogr. 2013 Apr;26(4):410-8. - Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry.
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Gaasch WH, Zile MR.
J Am Coll Cardiol. 2011 Oct 18;58(17):1733-40. - Defining left ventricular hypertrophy in children on peritoneal dialysis.
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Borzych D, Bakkaloglu SA, Zaritsky J, Suarez A, Wong W, Ranchin B, Qi C, Szabo AJ, Coccia PA, Harambat J, Mitu F, Warady BA, Schaefer F; International Pediatric Peritoneal Dialysis Network.
Clin J Am Soc Nephrol. 2011 Aug;6(8):1934-43. - Controversies in the assessment of left ventricular mass.
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Gidding SS.
Hypertension. 2010 Jul;56(1):26-8. - Left ventricular mass: allometric scaling, normative values, effect of obesity, and prognostic performance.
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Chirinos JA, Segers P, De Buyzere ML, Kronmal RA, Raja MW, De Bacquer D, Claessens T, Gillebert TC, St John-Sutton M, Rietzschel ER.
Hypertension. 2010 Jul;56(1):91-8. - Age-specific reference intervals for indexed left ventricular mass in children.
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Khoury PR, Mitsnefes M, Daniels SR, Kimball TR.
J Am Soc Echocardiogr. 2009 Jun;22(6):709-14. - Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study.
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Pettersen MD, Du W, Skeens ME, Humes RA.
J Am Soc Echocardiogr. 2008 Aug;21(8):922-34. - A novel method of expressing left ventricular mass relative to body size in children.
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Foster BJ, Mackie AS, Mitsnefes M, Ali H, Mamber S, Colan SD.
Circulation. 2008 May 27;117(21):2769-75. - Does size matter? Clinical applications of scaling cardiac size and function for body size.
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Dewey FE, Rosenthal D, Murphy DJ Jr, Froelicher VF, Ashley EA.
Circulation. 2008 Apr 29;117(17):2279-87. - New reference values for echocardiographic dimensions of healthy Dutch children.
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Overbeek LI, Kapusta L, Peer PG, de Korte CL, Thijssen JM, Daniels O.
Eur J Echocardiogr. 2006 Mar;7(2):113-21. - Echocardiography-based left ventricular mass estimation. How should we define hypertrophy?
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Foppa M, Duncan BB, Rohde LE.
Cardiovasc Ultrasound. 2005 Jun 17;3:17. - Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe
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Kampmann C, Wiethoff CM, Wenzel A, Stolz G, Betancor M, Wippermann CF, Huth RG, Habermehl P, Knuf M, Emschermann T, Stopfkuchen H.
Heart. 2000 Jun;83(6):667-72. - Factors affecting left ventricular mass in childhood: the Muscatine Study.
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Malcolm DD, Burns TL, Mahoney LT, Lauer RM.
Pediatrics. 1993 Nov;92(5):703-9.
Contact
Issues with the website can be directed to the issue tracker.
You can also send me an email at:
dan [at] parameterz [dot] com.
Note
I recently updated the site (Feb 2016), adding lots of new reference values. If, for some reason, you prefer the previous version, it can still be found here.