Distribution and Categorization of Echocardiographic Measurements in Relation to Reference Limits: The Framingham Heart Study: Formulation of a Height- and Sex-Specific Classification and Its Prospective Validation
Abstract
Background Despite widespread categorization of echocardiographic measurements, there are no standardized guidelines for partitioning values exceeding reference limits. Methods and Results We used regression analyses to develop sex- and height-specific reference limits for cardiac M-mode measurements (left ventricular [LV] mass, LV wall thickness, and LV and left atrial dimensions) in a healthy reference sample (n=1099) from the Framingham Heart Study. We then examined the distribution of measurements in a broad sample (n=4957) and classified the measurements according to increasing deviation from the height- and sex-specific reference limits and the 95th, 98th, and 99th percentile values for the broad sample (categories 0 through 4, respectively). To validate the categorization scheme, we used multivariable proportional-hazards regression to assess the relations of LV mass and LV wall thickness categories to risk of cardiovascular events and the relations of left atrial size to risk of atrial fibrillation. During a mean follow-up period of 7.7 years, 587 subjects developed new cardiovascular disease events, and 166 subjects developed new-onset atrial fibrillation. After adjustment for known risk factors, there was a 1.2- and 1.3-fold risk of cardiovascular disease events per category of LV wall thickness and LV mass, respectively, and a 1.6-fold risk of atrial fibrillation per category of left atrial size. Conclusions Using a large community-based study sample, we propose a classification scheme that provides a standardized and validated framework for partitioning echocardiographic measurements. If adopted, the categorization scheme should promote uniformity in describing measurements among echocardiographic laboratories and enhance the comprehensibility of measurements to clinicians.
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A number of observational studies have demonstrated the association between female sex and risk of AF-related stroke and thromboembolism.
“A number of observational studies have demonstrated the association between female sex and risk of AF-related stroke and thromboembolism (Supplementary Table S6).”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [70]
Most studies report an increased risk of stroke in women with atrial fibrillation.
“most studies report an increased risk of stroke in women.68–71”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [70]
Some studies suggest that female sex might be a significant risk factor for AF only for those above the age of 75 years.
“Some studies suggest that female sex might be a significant risk factor for AF only for those above the age of 75 years.69,70”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [70]
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- Authors
- Vasan, R. S., Larson, M. G., Levy, D., Evans, J. C., & Benjamin, E. J.
- Affiliations
- Harvard University (US)
- Venue
- Circulation
- Published
- 1997-09-16
- Volume
- 96
- Issue
- 6
- Pages
- 1863-1873
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1997065988
- Cited by
- 248
- References
- 50
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 5 · 2023: 16 · 2022: 9 · 2021: 4 · 2020: 9 · 2019: 10 · 2018: 5 · 2017: 5 · 2016: 10 · 2015: 8 · 2014: 10 · 2013: 8 · 2012: 7
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (N0I-HC-38038)
- National Institute of Neurological Disorders and Stroke (2-ROI-NS-17950-11)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- reference limits, left ventricular mass, left ventricular wall thickness, left atrial size, M-mode echocardiography, cardiovascular risk, atrial fibrillation, cardiovascular events, percentiles
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Body Height, Cardiovascular Diseases, Echocardiography, Female, Follow-Up Studies, Heart Ventricles, Humans, Male, Middle Aged, Prospective Studies, Reference Values, Reproducibility of Results, Multivariate Analysis, Treatment Outcome, Sex Distribution
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