Comparative Study Of Two-dimensional Echocardiographic Parameters In Healthy Adults Between China And Asian-European Countries

Background:We usually adopt the reference values of echocardiography from the international guidelines established from American and European populations.Recent studies have shown that there exist significant differences between gender,age and race in two-dimensional echocardiography(2DE)parameters.But so far there is lack of comparative studies in 2DE measurements based on representative population,large sample and multiple countries.Objective:The present study aimed to investigate the differences and similarities of 2DE parameters in healthy adults between gender,age and Chinese,Japanese and Europeans.Methods:Based on database from the Echocardiographic Measurements in Normal Chinese Adults(EMINCA)study,we ’respectively compared the 2DE measurements and their BSA-or height-corrected values stratified by gender and age between EMINCA study and the Japanese Normal Values for Echocardiographic Measurements Project(JAMP)study,and between EMINCA study and the Normal Reference Ranges for Echocardiography(NORRE)study.Results:1.In the EMINCA study,there existed inter-gender differences in 23(23/23)2DE parameters,inter-age differences in 13(13/18)for men and 14(14/18)for women(P<0.001).Inter-gender discrepancies remained in 16(16/16)BSA-corrected parameters and inter-age discrepancies remained in 11(11/14)for men and 10(10/14)BSA-corrected parameters for women.There remained inter-gender differences in 1(1/3)height-corrected aortic diameters(P<0.001).In the JAMP study,inter-gender discrepancies were observed in all 17(17/17)measurements,and inter-age discrepancies were found in 12(12/17)measurements for males and in 9(9/17)measurements for females(P<0.001).When indexing with BSA,inter-gender differences remained in 12(12/14)parameters,and inter-age differences remained in 8(8/14)in men and 12(12/14)parameters in women respectively(P<0.001).In the NORRE study,inter-gender discrepancies were found in 23(23/23)parameters and inter-age discrepancies were shown in 5(5/8)for males and in 6(6/8)parameters for females respectively(P<0.001).After correcting with BSA,inter-gender differences remained in 11(11/12)measurements,and there existed inter-age differences in 2(2/4)for males and 3(3/4)parameters for females(P<0.001).Two of three height-corrected aortic measurements showed significant differences between gender(P<0.001).2.For the same 15 same parameters between EMINCA and JAMP studies,2(2/15)were greater and 7(7/15)parameters were smaller in the EMINCA study than in the JAMP study for men;1(1/15)was larger and 5(5/15)parameters were smaller in the EMINCA study than in the JAMP study for women(P<0.001).When indexing with BSA,1(1/12)parameter was larger and 9(9/12)parameters were smaller in the EMINCA study than in the JAMP study for men;1(1/12)parameter was larger and 8(8/12)parameters were smaller in the EMINCA study than in the JAMP study for women(P<0.001).3.For the 17 similar parameters between EMINCA and NORRE studies,in comparison with the EMINCA study,2(2/17)measurements were larger and 14(14/17)measurements were smaller than the NORRE study for the total study population,and 1(1/17)measurement was larger and 15(15/17)measurements were smaller for men and 1(1/17)measurement was larger and 14(14/17)measurements were smaller for women in the EMINCA study.After correcting with BSA,2(2/10)were larger and 7(7/10)measurements were smaller in the EMINCA study than in the NORRE study for the overall population,males and females populations respectively(P<0.001).When indexing with height,1(1/3)parameter was larger and 2(2/3)parameters were smaller in the EMINCA study than in the NORRE study for total and women population;1(1/3)parameter was similar and 2(2/3)parameters were smaller in the EMINCA study than in the NORRE study for men(P<0.001).Conclusion:1.In healthy adults,there are significant differences in measurements of 2DE parameters between genders,age groups and races.2.Most 2DE parameters differ between Chinese and Japanese and between Chinese and Europeans.Chinese cardiac cavity and aortic diameters are slightly smaller than Japanese and significantly less than Europeans.3.Linear correction of 2DE parameters by BSA or height does not eliminate the physiological variance generated by sex,age and race.Therefore,sex,age and race-specific normal reference values should be preferred clinically,and further studies are needed to explore more reasonable methods for correction.