Echocardiographic Measurements in Normal Chinese Adults (EMINCA) II focusing on left ventricular and left atrial size and function by three-dimensional echocardiography

Abstract

Current guidelines encourage large studies in a diverse population to establish normal reference ranges for three-dimensional (3D) echocardiography for different ethnic groups. This study was designed to establish the normal values of 3D-left ventricular (LV) and left atrial (LA) volume and function in a nationwide, population-based cohort of healthy Han Chinese adults. A total of 1117 healthy volunteers aged 18–89 years were enrolled from 28 collaborating laboratories in China. Two sets of 3D echocardiographic instruments were used, and full-volume echocardiographic images were recorded and transmitted to a core laboratory for image analysis with a vendor-independent off-line workstation. Finally, 866 volunteers (mean age of 48.4 years, 402 men) were qualified for final analysis. Most parameters exhibited substantial differences between different sex and age groups, even after indexation by body surface area. The normal ranges of 3D-LV and 3D-LA volume and function differed from those recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines, presented by the World Alliance Societies of Echocardiography (WASE) study, and from the 2D values in the EMINCA study. The normal reference values of 3D echocardiography-derived LV and LA volume and function were established for the first time in healthy Han Chinese adults. Normal ranges of 3D-LV and 3D-LA echocardiographic measurements stratified with sex, age, and race should be recommended for clinical applications.

Keywords

three-dimensional echocardiography / left ventricle / left atrium / normal reference values / Chinese adults

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Acknowledgements

General The following hospitals (investigators) participated in this study: Qilu Hospital of Shandong University (Qingdao) (Xiangyun Chen), West China Hospital, Sichuan University (Wenjuan Bai), Shenzhen People’s Hospital/The Second Clinical Medical College of Jinan University (Bobo Shi, Yingying Liu), Electronic Science and Technology University of China, The Affiliated Sichuan Provincial People’s Hospital (Shuang Li), Peking University People’s Hospital (Zhilong Wang), Henan Provincial People’s Hospital (Changhua Wei), The First Affiliated Hospital of Harbin Medical University (Shuhan Qi), The First Affiliated Hospital of China Medical University (Chunyan Ma, Ru Yang), Zhongshan Hospital, Fudan University (Minmin Sun, Dehong Kong), Beijing Anzhen Hospital, Capital Medical University (Rongjuan Li), The First Hospital Affiliated to Army Medical University (South-west Hospital) (Haiyun Huang), Shengjing Hospital of China Medical University (Yangjie Xiao), China-Japan Union hospital of Jilin University (Haiyan Feng), The First Affiliated Hospital of the Medical College, Shihezi University (Lei Huang, Wenjuan Qin), The First Affiliated Hospital of Guangxi Medical University (Chunlan Jiang), The First Affiliated Hospital of Xinjiang Medical University (Yanhong Li), The Second Affiliated Hospital of Harbin Medical University (Guoqing Du), Wuhan Asia Heart Hospital (Juan Xia), Fuwai Hospital, Chinese Academy of Medical Sciences (Xin Quan), Jiangsu Province Hospital (Jing Yao), Tangdu Hospital of Air Force Medical University of PLA (Pengfei Chen, Yuxin Zhang), Qingdao Municipal Hospital (Qiang Chu), Yan’an Hospital Affiliated to Kunming Medical University (Qingyi Luo, Li Zhao), The People’s Hospital of Liaoning Province (Hanzhang Zhao), Renmin Hospital of Wuhan University/Hubei General Hospital (Chuangli Feng). We thanked them for their contributions to this study.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-023-1045-3 and is accessible for authorized users.

Compliance with ethics guidelines

Conflict of interest Yingbin Wang, Yu Zhang, Guihua Yao, Hong Tang, Lixin Chen, Lixue Yin, Tiangang Zhu, Jianjun Yuan, Wei Han, Jun Yang, Xianhong Shu, Ya Yang, Yulin Wei, Yanli Guo, Weidong Ren, Dongmei Gao, Guilin Lu, Ji Wu, Hongning Yin, Yuming Mu, Jiawei Tian, Lijun Yuan, Xiaojing Ma, Hongyan Dai, Yunchuan Ding, Mingyan Ding, Qing Zhou, Hao Wang, Di Xu, and Mei Zhang declare that they have no conflict of interest. Yun Zhang, a member of the Editorial Board of Frontiers of Medicine, was excluded from the peer-review process and all editorial decisions related to the acceptance and publication of this article. Peer review was handled independently by the other editors to minimize bias.

This study was registered as ChiCTR-OCS-12002119 at the Chinese Clinical Trial Registry. It is an authorized registry organization of the International Clinical Trial Registry Platform of the World Health Organization. The study was approved by the ethical committees of all collaborating centers and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all volunteers participating in this study.

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