Clinical Investigation
World Alliance Societies of Echocardiography Normal Values
Left Ventricular Diastolic Function in Healthy Adult Individuals: Results of the World Alliance Societies of Echocardiography Normal Values Study

https://doi.org/10.1016/j.echo.2020.06.008Get rights and content

Highlights

  • Compared to the ASE/EACVI recommendations, the ULN for LAVI in WASE is larger.

  • Compared to the ASE/EACVI recommendations, LLN for e' velocities is lower.

  • Most diastolic parameters significantly changed as the age of the population increased.

  • The ASE/EACVI algorithm to determine diastolic function in normal LVEF performed well.

  • Normal LV diastolic parameters, most importantly the LAVI, must be redefined.

Background

The World Alliance Societies of Echocardiography (WASE) study was conducted to describe echocardiographic normal values in adults and to compare races and nationalities using a uniform acquisition and measurement protocol. This report focuses on left ventricular (LV) diastolic function.

Methods

WASE is an international, cross-sectional study. Participants were enrolled with equal distribution according to age and gender. Echocardiograms were analyzed in a core laboratory based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Left ventricular diastolic function was assessed by E, E/A, e' velocities, E/e', left atrial volume index (LAVI), and tricuspid regurgitation velocity. Determination of LV diastolic function was made using the algorithm proposed by the guidelines.

Results

A total of 2,008 subjects from 15 countries were enrolled. The majority were of white or Asian race (42.8%, 41.8%, respectively). E and E/e' were higher in female patients, while LAVI was similar in both genders. Consistent increase in E/e' and decrease in E/A, E, and e' were found as age increased. The upper limit of normal for LAVI was higher in WASE compared with the guidelines. The lower limits of normal for e' were smaller in elder groups than those in the guidelines, while the upper limits of normal for E/e' were below the guideline values. These findings suggest that the cutoff value for LAVI should be shifted upward and age-specific cutoff values for e' should be considered. In WASE, <93.6% of patients were classified as normal LV diastolic function using the guidelines' algorithm, and the proportion increased to 97.4% when applying the revised cutoff values for LAVI obtained in our study.

Conclusions

Guideline-recommended normal values for e' velocities and LAVI should be reconsidered. The algorithm for the determination of LV diastolic function proposed by the guidelines is useful, but adjustments to LAVI could further improve it.

Keywords

Diastolic function
Normal values
WASE
Echocardiography
International

Abbreviations

ASE
American Society of Echocardiography
EACVI
European Association of Cardiovascular Imaging
LA
Left atrium, atrial
LAVI
Left atrial volume index
LLN
Lower limit of normal
LV
Left ventricle, ventricular
LVEF
Left ventricular ejection fraction
NORRE
Normal Reference Ranges for Echocardiography
TR
Tricuspid regurgitation
ULN
Upper limit of normal
WASE
World Alliance Societies of Echocardiography

Cited by (0)

A full list of World Alliance Societies of Echocardiography (WASE) investigators is provided at the end of the article.

Conflicts of Interest: A.B. is an employee of TOMTEC Imaging Systems GmbH. No other direct conflicts of interest related to this study has been reported by any of the authors. All authors have been involved in the design of the WASE study, patient enrollment, and/or data analysis, and all have critically reviewed and accepted the final manuscript prior to submission.

This work was supported by the American Society of Echocardiography Foundation, MedStar Health Research Institute, and the University of Chicago, with in-kind support from TOMTEC and Intelemage/Medidata.

View Abstract