Normal Values of Right Atrial Size and Function According to Age, Sex, and Ethnicity: Results of the World Alliance Societies of Echocardiography Study - 26/12/20

Doi : 10.1016/j.echo.2020.11.004

Laurie Soulat-Dufour, MD ^a, Karima Addetia, MD ^a, Tatsuya Miyoshi, MD ^b, Rodolfo Citro, MD ^c, Masao Daimon, MD, PhD ^d, Pedro Gutierrez Fajardo, MD, FASE ^e, Ravi R. Kasliwal, MD, FASE ^f, James N. Kirkpatrick, MD, FASE ^g, Mark J. Monaghan, PhD ^h, Denisa Muraru, MD, FASE ⁱ, Kofo O. Ogunyankin, MD, FASE ^j, Seung Woo Park, MD ^k, Ricardo E. Ronderos, MD, FASE ^l, Anita Sadeghpour, MD, FASE ^m, Gregory M. Scalia, MD, FASE ⁿ, Masaaki Takeuchi, MD, PhD, FASE ^o, Wendy Tsang, MD ^p, Edwin S. Tucay, MD, FASE ^q, Ana Clara Tude Rodrigues, MD ^r, Amuthan Vivekanandan, MD, DM, FASE ^s, Yun Zhang, MD, FASE ^t, Markus Diehl, MS ^u, Marcus Schreckenberg, MS ^u, Victor Mor-Avi, PhD, FASE ^a, Federico M. Asch, MD, FASE ^b, Roberto M. Lang, MD, FASE ^a,^⁎
on Behalf of
the WASE Investigators
Aldo D. Prad, Agatha Kwon, Samantha Hoschke-Edwards, Tania Regina Afonso, Babitha Thampinathan, Maala Sooriyakanthan, Tiangang Zhu, Zhilong Wang, R. Alagesan, Azin Alizadehasl, Luigi Badano, Tomoko Nakao, Takayuki Kawata, Megumi Hirokawa, Naoko Sawada, Hye Rim Yun, Ji-won Hwang

^a University of Chicago, Chicago, Illinois
^b MedStar Health Research Institute, Washington, District of Columbia
^c University of Salerno, Salerno, Italy
^d The University of Tokyo, Tokyo, Japan
^e Hospital Bernardette, Guadalajara, Mexico
^f Medanta Medicity, Gurgaon, India
^g University of Washington, Seattle, Washington
^h King's College Hospital, London, United Kingdom
ⁱ University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
^j First Cardiology Consultants Hospital Ikoyi, Lagos, Nigeria
^k Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea
^l Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
^m Rajaie Cardiovascular Medical Center, IUMS, Tehran, Iran
ⁿ GenesisCare, Brisbane, Australia
^o University of Occupational and Environmental Health, Kitakyushu, Japan
^p Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
^q Philippine Heart Center, Quezon City, Philippines
^r Hospital Israelita Albert Einstein, São Paulo, Brazil
^s Jeyalakshmi Heart Center, Madurai, India
^t Qilu Hospital of Shandong University, Jinan, China
^u TOMTEC Imaging Systems, Unterschleissheim, Germany

^∗Reprint requests: Roberto M. Lang, MD, FASE, University of Chicago, 5758 S Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637.University of Chicago5758 S Maryland AvenueMC 9067DCAM 5509ChicagoIL60637

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 26 December 2020
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Abstract

Background

The World Alliance Societies of Echocardiography study is a multicenter, international, prospective, cross-sectional study whose aims were to evaluate healthy adult individuals to establish age- and sex-normative values of echocardiographic parameters and to determine whether differences exist among people from different countries and of different ethnicities. The present report focuses on two-dimensional (2D) and three-dimensional (3D) right atrial (RA) size and function.

Methods

Transthoracic 2D and 3D echocardiographic images were obtained in 2,008 healthy adult individuals evenly distributed among subgroups according to sex (1,033 men, 975 women) and age 18 to 40 years (n = 854), 41 to 65 years (n = 653), and >65 years (n = 501). For ethnicity, 34.9% were white, 41.6% Asian, and 9.7% black. Images were analyzed in a core laboratory according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. RA measurements included 2D dimensions, 2D and 3D RA volumes (RAVs) indexed to body surface area (BSA), emptying fraction (EmF), and global longitudinal strain, including total/reservoir, passive/conduit, and active/contractile phases. Differences among age and sex categories and among countries were also examined.

Results

RAVs were larger in men (even after BSA indexing), while 3D total EmF and global longitudinal strain magnitudes were higher in women. For both sexes, there were no significant age-related differences in 2D RAV measurements, but 3D RAV values differed minimally with age, remaining significant after BSA indexing. RA total EmF and reservoir strain and passive EmF and conduit strain magnitude were lower in older groups for both sexes. Interestingly, whereas RA active EmF increased with age, contractile strain magnitude decreased. Considerable geographic variations were identified: Asians of both sexes had significantly lower BSA than non-Asians, and their 2D and 3D end-systolic RAVs were significantly smaller even after BSA indexing. Of note, 2D end-systolic RAVs in this group were considerably lower than normal values provided in the current guidelines.

Conclusions

There is significant sex, age, and geographic variability in normal RA size and function parameters. Current guideline-recommended normal ranges for RA size and function parameters should be adjusted geographically on the basis of the results of this study.

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Highlights

•	Normative values of 2D and 3D echocardiographic right atrial size and function.
•	2D dimensions, 2D and 3D volumes, emptying fractions, global longitudinal strain.
•	Sex-, age- and geographic variability in normal RA size and function parameters.
•	Current recommendations should be adjusted based on the results of this study.

Le texte complet de cet article est disponible en PDF.

Keywords : Normal values, Right atrium, Right atrial volume, Right atrial strain

Abbreviations : 2D, 3D, ASE, BSA, EACVI, ED, EmF, ES, GLS, NORRE, RA, RAV, WASE

Plan

Methods

Study Design and Population

Echocardiographic Image Acquisition and Analysis Protocol

Statistical Analysis

Results

Sex Differences in RA Size and Function

Geographic Differences in RA Size and Function

Discussion

Rationale for the 3D WASE Study

Two-Dimensional and 3D RA Dimension and Volumes

RA Function

Sex Differences in RA Size and Function

Geographic Differences in RA Size and Function

Limitations

Clinical Implications of a Comprehensive Assessment of the Right Atrium

Conclusion

Additional WASE Investigators

Supplementary Data

Dr. Soulat-Dufour has received a grant from Fédération Française de Cardiologie. Mr. Diehl and Mr. Schreckenberg are employees of TomTec Imaging Systems. All authors have been involved in the design of the WASE study, patient enrollment, and/or data analysis, and all have critically reviewed and approved the final manuscript prior to submission. A full list of WASE investigators is provided in the Appendix. Jordan B. Strom, MD, FASE, served as guest editor for this report.