Determination of Left Ventricular Mass by Echocardiography in a Normal Population: Effect of Age and Sex in Addition to Body Size

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Objective

In this study, we determined the effect of age, sex, and body size on left ventricular mass.

Design

Two-dimensional-guided M-mode echocardiography was used in an assessment of 111 healthy, normal adults.

Material and Methods

Left ventricular mass was calculated with the cube function formula corrected by a regression equation to agree with autopsy estimates of left ventricular mass. Calculated left ventricular mass, indexed by body surface area and by height, was analyzed on the basis of sex and age of the study participants. Age was analyzed as a dichotomous, trichotomous, and continuous variable. The effects of age, sex, and obesity, as well as interactions, were tested within a multiple linear regression model framework.

Results

Left ventricular mass, when indexed for either body surface area or height, was greater in men than in women. For women, but not men, we found a small but significant increase in left ventricular mass with advancing age. Body mass index, an indicator of obesity, increased with aging in women but not in men and affected left ventricular mass. No significant changes were noted in left ventricular cavity size with advancing age, and the increase in left ventricular mass in women was due to increased ventricular wall thickness.

Conclusion

The findings in this study suggest that left ventricular mass, as assessed by two-dimensional-guided M-mode echocardiography, is affected not only by sex and body size but also by age in women. This phenomenon may be related to an increase in body mass index with advancing age in women. In clinical studies that use echocardiographic left ventricular mass to diagnose left ventricular hypertrophy, these observations should be considered.

Section snippets

Study Participants.

As part of an investigation of the effect of age on left ventricular dimensions and filling dynamics in normal, healthy persons,6 a two-dimensional-guided M-mode echocardiographic study was performed in 117 healthy adult volunteers who resided in Olmsted County, Minnesota. Six of these subjects (5%) were excluded from further analysis because of technically inadequate measurements. Of the 111 remaining subjects, 47 were male and 64 were female; 108 were white. As determined by interview, 8 of

RESULTS

Echocardiography measurements for both male and female subjects stratified by age are shown in Table 3. When indexed for height (108 ± 17 g/m), left ventricular mass was numerically similar to but slightly more than when it was indexed for body surface area (99 ± 15 g/m2) among men. When indexed for either body surface area or height, left ventricular mass was higher in male than in female subjects. In a parallel age-slope model, left ventricular mass was higher in men than in women by 46 g/m2.

DISCUSSION

The results of this study suggest that left ventricular mass, as assessed by two-dimensional-guided M-mode echocardiography, is affected by age in women but not in men. This observation does not seem to be explained by higher blood pressures in older women than in younger female subjects. A small increase in body mass index with advancing age was noted in women but not in men, but the mean body mass index was within the normal range.8 This effect could have explained the different sex responses

CONCLUSION

Left ventricular mass, as assessed by two-dimensional-guided M-mode echocardiography, is affected not only by body size and sex but also by age in women. In our laboratory, all three factors are considered when the presence of left ventricular hypertrophy is determined. Thus, left ventricular hypertrophy can be diagnosed when left ventricular mass, indexed for body size, exceeds the upper 95% confidence interval of normal for each sex. In clinical studies that use echocardiographic left

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Current address: Cleveland Clinic Foundation, Cleveland, Ohio.

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