Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland.
J Am Soc Echocardiogr. 2012 Dec;25(12):1251-8. doi: 10.1016/j.echo.2012.08.013. Epub 2012 Sep 11.
Published reference values for echocardiographic measurements of right-heart dimensions and function do not stratify for gender and body size. The aim of this study was therefore to assess the impact of gender and biometric characteristics on right-heart dimensions and function.
From the echocardiography database at a tertiary care center, 1,625 subjects (mean age, 44 ± 14 years; 47% men) with normal echocardiographic findings between 2000 and 2009 were identified. Gender differences and association with body surface area were assessed retrospectively for right atrial long-axis and short-axis dimensions, right ventricular short-axis dimension, end-diastolic and end-systolic right ventricular area, right ventricular fractional area change, and tricuspid annular plane systolic excursion. The impact of normal values stratified for gender and body surface area was tested in 24 patients with moderate-sized to large atrial septal defects.
All dimensional right-heart measurements were significantly lower in women. Differences became smaller when measurements were indexed for body surface area, but significant differences persisted, particularly for right ventricular end-diastolic area (7.9 ± 1.6 vs 8.7 ± 1.8 cm(2)/m(2), P < .001) and right ventricular end-systolic area (4.0 ± 1.2 vs 4.7 ± 1.4 cm(2)/m(2), P < .001). Fractional area change and tricuspid annular plane systolic excursion indexed to body surface area were significantly higher in women (50 ± 7% vs 46 ± 9% and 14 ± 3 vs 12 ± 2 mm/m(2), respectively, P < .001 for both comparisons). The use of upper reference ranges for end-diastolic right ventricular area stratified for gender and body surface area improved the detection of enlarged right ventricles in patients with moderate-sized to large atrial septal defects (92% vs 54%, P < .007).
Gender and body surface area are important determinants of right ventricular dimensions and systolic function as measured on two-dimensional echocardiography. The investigators thus propose the use of measurements indexed to body surface area, with upper and lower reference ranges stratified for gender.
发表的超声心动图右心结构和功能测量参考值没有按性别和体型分层。因此，本研究旨在评估性别和人体测量特征对右心结构和功能的影响。
从 2000 年至 2009 年在一家三级医疗中心的超声心动图数据库中，确定了 1625 例（平均年龄 44 ± 14 岁，47%为男性）超声心动图正常的患者。回顾性评估了右心房长轴和短轴、右心室短轴、舒张末期和收缩末期右心室面积、右心室射血分数、三尖瓣环平面收缩期位移的性别差异和与体表面积的相关性。在 24 例中至大型房间隔缺损患者中，对按性别和体表面积分层的正常参考值进行了测试。
女性的所有右心结构的二维测量值均显著较低。当按体表面积校正时，差异变小，但仍有显著差异，尤其是右心室舒张末期面积（7.9 ± 1.6 比 8.7 ± 1.8 cm2/m2，P <.001）和右心室收缩末期面积（4.0 ± 1.2 比 4.7 ± 1.4 cm2/m2，P <.001）。按体表面积校正的射血分数和三尖瓣环平面收缩期位移也显著较高（分别为 50 ± 7%比 46 ± 9%和 14 ± 3 比 12 ± 2 mm/m2，两者比较 P <.001）。按性别和体表面积分层的舒张末期右心室面积的上参考范围改善了中至大型房间隔缺损患者中扩大右心室的检出率（92%比 54%，P <.007）。
性别和体表面积是二维超声心动图测量的右心室大小和收缩功能的重要决定因素。因此，研究者提出使用按体表面积校正的测量值，并按性别分层上下参考范围。
