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Echocardiographic Measurements of Left Heart Chamber Size in a Large Cohort of Subjects: Comparison of Body Surface Area and Height Indexing to Account for Effects of Obesity.

Journal of the American Society of Echocardiography(2022)

Hosp Univ Fdn Favaloro | Univ Favaloro CONICET | Solis 453

Cited 4|Views22
Abstract
Background: The assessment of cardiac chamber size in the obese population is a challenging subject. Values usually indexed to body surface area (BSA) are smaller in obese subjects and prone to overcorrection. The aims of this study were to find reference thresholds to account for the effects of obesity among a large cohort of patients and to evaluate indexing to height as an alternative to BSA. Methods: The past 10 years of records from a single echocardiography unit were retrospectively analyzed, and 14,007 subjects without known cardiac disease were included (mean age, 45 +/- 15 years; 54% women; 20% obese). Measurements included left atrial diameter, area, and volume, left ventricular (LV) end-diastolic and end-systolic diameters, aortic root diameter, and LV mass. Absolute, BSA-indexed, and height-indexed maximum thresholds (mean + 1.96 SDs) were calculated. Allometric indexing of the form variable/heighe was tested. Correlation coefficients between indexed and absolute values were calculated to evaluate their proportional association (ideally r = 1). Correlations between indexed values and body size represented residual associations to be minimized (ideally r = 0). Results: The strongest association of echocardiographic measurements with body size was observed for BSA (r = 0.36-0.63), whereas the isometric and allometric height models showed lower comparable values (r = 0.28-0.48). Positive correlations with body mass index were mostly observed for left atrial size (r approximate to 0.36) and LV mass (r approximate to 0.36) measurements. Values of the scaling exponent beta for allometric height indexing were 1.72 for left atrial volume and 2.33 for LV mass. Correlations between indexed and absolute values were higher for height than BSA (0.80-0.98 vs 0.44-0.92). Correlations between indexed values and height were closer to 0 than for BSA, particularly using the allometric model. The overcorrection observed with increasing obesity class after BSA indexing was avoided after height indexing. Conclusions: Unlike BSA, height indexing provided adequate body size scaling of left heart chamber size, avoiding overcorrection using allometric models in particular.
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Key words
Obesity,Echocardiography,Left heart,Body size
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要点】:该研究通过大型队列数据分析,探讨了使用身高指数替代体表面积指数来调整肥胖患者左心室大小的测量值,以减少过度校正问题。

方法】:研究回顾性分析了单一超声心动图单位过去10年的记录,共纳入14,007名无已知心脏疾病的受试者,计算了绝对值、体表面积指数和身高指数的最大阈值,并测试了变量/身高的幂次法则(allometric indexing)。

实验】:通过分析左心房直径、面积、体积、左心室舒张末期和收缩末期直径、主动脉根部直径和左心室质量的数据,比较了体表面积和身高指数与实际测量值的相关性,以及不同指数方法在肥胖患者中的应用效果。结果显示,与体表面积指数相比,身高指数提供了更合适的身体尺寸调整,特别是在使用幂次法则模型时。