Normal values of three-dimensional echocardiographic right ventricular (3D-RV) volume established in Chinese adults

This prospective and multicenter study was led by Dr. Yun Zhang and Dr. Mei Zhang (Qilu hospital of Shandong university). Previous study by this team (Echocardiographic Measurements in Normal Chinese Adults, EMINCA) reported normal values of two-dimensional echocardiographic and Doppler echocardiography in healthy Chinese adults, which were published in J Am Soc Echocardiogr, 2015; 28(5):570-579 and Eur Heart J Cardiovasc Imaging, 2016; 17(5):512-522. Three-dimensional (3D) echocardiography is an emerging technique for assessing RV volume and function, but the normal values of RV volume and function by 3D echocardiography in the Chinese population are still lacking.

The EMINCA II study was designed and conducted from September 2016 to February 2020, with the purpose of establishing normal reference values of left and right ventricular and atrial size and function by 3D echocardiography in a large cohort of healthy Han volunteers, and examining the physiological and instrumental factors that may affect these normal values. A total of 1117 healthy Han Chinese volunteers aged 18 to 89 years were enrolled from 28 collaborating laboratories in 20 provinces and municipalities of China. 3D-RV images from 747 volunteers with optimal image quality were qualified for final analysis by Dr. Yu Zhang and Dr. Ying-bin Wang from the core laboratory in a blinded way.

The results showed that men had larger RV volumes than women in the whole population, even after indexing to body surface area, and the elderly had smaller RV volumes. The normal values of RV volumes were significantly smaller than those recommended by ASE/EACVI guidelines in both sexes. There were significant differences in 3D RV measurements between two vendor’s ultrasound systems and between different software platforms.

Based on these results, a set of normal values of 3D-RV volume and function in a large Chinese population was first presented. 3D-RV enlargement was defined as RVEDVi>76 ml/m² in men and RVEDVi>72 ml/m² in women, and 3D-RV systolic dysfunction was defined as RVEF<46% in men and RVEF<47% in women. In view of the significant difference in normal ranges of 3D-RV volume and function reported by EMINCA II and ASE/EACVI guidelines, the criteria of 3D-RV enlargement and systolic dysfunction defined by EMINCA II should be adopted in clinical diagnosis of cardiac disease involving RV in clinical practice.

This study was funded in part by the National Natural Science Foundation of China, State Key R&D Program of China, and Key R&D Program of Shandong Province.