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Rashid A, Shah AA, Rather H, Rasool V, Hafeez I, Ajaz S, Purra S, Lone AA. Echocardiographic Measurements in Normal Healthy Adult Population of North India. Cureus 2023; 15:e47449. [PMID: 38022041 PMCID: PMC10660080 DOI: 10.7759/cureus.47449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND AIM Interpretation of imaging modalities depends on robust normal reference limits. Ethnicity is an essential determinant of cardiac chamber sizes. Though few studies from India have focused on this research, it has yet to include the Kashmiri population. We aimed to study normal echocardiographic values of healthy Kashmiri adults and compare them with Western and Indian studies. METHODS It was a prospective observational study on healthy adults of Kashmir Valley. A comprehensive echocardiographic analysis following standardized protocols was performed. RESULTS A total of 2245 study participants were analyzed. The mean age was 32.52±11.55 years. There were 1100 (49%) males. Males had higher absolute left ventricular volumes and mass, left atrial volumes, right ventricular diameter, and aortic size, while females had higher absolute left ventricular ejection fraction and early and late diastolic mitral inflow velocities. Males had higher indexed left ventricular end-systolic volume, while females had higher indexed left ventricular end diastole diameter, aorta diameter, right ventricle, and left and right atrial sizes. Left ventricular mass and diastolic parameters were significantly associated with age. Compared with the American Society of Echocardiography/European Association of Cardiovascular Imaging, absolute values of left ventricle size, volumes, mass, right ventricle size, aortic size, and left and right atrial size were higher than those in our study. Our study population had a higher left ventricle ejection fraction. Among indexed parameters, left ventricle volumes, left ventricle systolic diameter, aortic annulus, and left and right atrial volumes were still significantly higher in Western data. While comparing with Indian data, we noted significant regional differences. CONCLUSION We provide normal reference values for our local population. We noted significant differences with Western as well as other Indian populations. Our study highlights the need for developing ethnic-specific reference values of various echocardiographic measurements.
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Affiliation(s)
- Aamir Rashid
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Aejaz A Shah
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Hilal Rather
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Vamiq Rasool
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Imran Hafeez
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Shahood Ajaz
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Sameer Purra
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Ajaz A Lone
- Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Vasan SK, Alex AG, Roy A, Gowri M, Sinha S, Suresh J, Philip RS, Kochumon J, Jaiswal N, Arulappan G, Ramakrishnan L, Sachdev HS, Tandon N, Thomas N, Jebasingh F, Osmond C, Karpe F, Bhargava SK, Antonisamy B, Prabhakaran D, Fall CH, Thomson VS. Echocardiography protocol and cardiometabolic phenotyping in Indian birth cohorts-the IndEcho study. Front Cardiovasc Med 2023; 10:1055454. [PMID: 37522075 PMCID: PMC10372793 DOI: 10.3389/fcvm.2023.1055454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography characteristics in two large Indian population-based cohorts (the New Delhi and Vellore Birth Cohorts) from India. Methods The IndEcho study captured transthoracic echocardiographic measurements of cardiac structure and function from 2,322 men and women aged 43-50 years. M-mode measurements in the parasternal long axis (PLAX) and 2-dimensional (2D) short axis recordings at the mitral valve, mid-papillary and apical level were recorded. Apical 2D recordings of two- three- and four-chamber (2C, 3C and 4C) views and Doppler images (colour, pulsed and continuous) were recorded in cine-loop format. Left ventricular (LV) mass, LV hypertrophy, and indices of LV systolic and diastolic function were derived. Results Echocardiographic measurements showed good/excellent technical reproducibility. Hetero-geneity across sites, sex and rural/urban differences in cardiac structure and function were observed. Overall, this cohort of South Asian Indians had smaller LV mass and normal systolic and diastolic function when compared with published data on other Asian Indians and the West, (LV mass indexed for body surface area: Delhi men: 68 g/m2, women 63.9; Vellore men: 65.8, women 61.6) but were within ethnic-specific reference ranges. The higher prevalence of obesity, diabetes and hypertension is reflected by the higher proportion of LV remodelling and lesser hypertrophy. Conclusions Our study adds to scarce population-based echocardiographic data for mid-life Asian Indians. Compared to published literature on other ethnic groups, the Asian Indian heart is characterised by smaller cardiac dimensions and normal range systolic and diastolic function on a background of a high prevalence of hypertension, diabetes and cardiac disease at a relatively young age. This data will form the basis for further analyses of lifecourse, metabolic and body composition predictors of cardiac structure and function, and echocardiographic predictors of future mortality. ISRCTN registration number 13432279.
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Affiliation(s)
- Senthil K. Vasan
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- Centre for Chronic Disease Control, Gurgaon, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Sikha Sinha
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Jenifer Suresh
- Department of Cardiology, Christian Medical College, Vellore, India
| | | | | | | | | | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research Institute, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Felix Jebasingh
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, New Delhi, India
| | - Caroline H.D. Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Viji S. Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
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Borde D, Chidambaram K, Sundar AS, Kulkarni V, Jasapara A, Shetty V, Gopinath R, Pathy A, Viswanath VVR, Asegaonkar B, Apsingkar P, Takalkar U, Joshi S, Chakravarthy M. Normative Transesophageal Echocardiographic Values of Cardiac Structures in the Indian Population-Indian Normative TEE Measurements (INTEEM) Study. J Cardiothorac Vasc Anesth 2021; 36:184-194. [PMID: 34344599 DOI: 10.1053/j.jvca.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Information on normative reference values for cardiac structures is critical for the accurate application of echocardiography for guiding clinical decision-making. Many studies using transthoracic echocardiography (TTE) have shown that Indians have smaller diameters of various cardiac structures. There are no normative studies for transesophageal echocardiography (TEE). The authors observed dimensions of various cardiac structures in healthy Indian patients under general anesthesia using TEE and compared them with existing guidelines from non-Indian data. DESIGN The Indian Normative TEE Measurements study was a multicenter, prospective observational study conducted in India. SETTING Operating rooms for noncardiac surgeries in tertiary care-level hospitals. PARTICIPANTS Adult patients undergoing noncardiac surgery who were free from any cardiac, respiratory, and renal diseases and had no contraindications for TEE. INTERVENTIONS After inducing general anesthesia and achieving stable hemodynamic conditions, a comprehensive TEE examination was performed and various measurements were made. MEASUREMENTS AND MAIN RESULTS For each of the 83 patients undergoing noncardiac surgery, 39 various measurements for left ventricle, right ventricle, both atria, and all valves were made. This included diameters and functional parameters. They were analyzed in a vendor-neutral software off-line. The absolute values of many of the measurements were higher in men, but when indexed to body surface area (BSA) they were similar in both sexes. The values were lower than most of the Western data but matched previous Indian studies using TTE. CONCLUSIONS The authors present normative values of various echocardiographic parameters using TEE. Because of its variations, it is recommended to use India-specific data to make decisions in Indian patients. It may be prudent to use BSA-indexed values during decision-making.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Kumar Chidambaram
- Department of Cardiac Anesthesia, Madras Medical Mission, Chennai, Tamilnadu, India
| | - Ayya Syama Sundar
- Department of Cardiac Anesthesia, Nizam's Institute of Medical Sciences, Hyderabad, Telanagana, India; Department of Anesthesiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Venugopal Kulkarni
- Department of Cardiac Anesthesia, Citizen's Hospital, Hyderabad, Telangana, India
| | - Amish Jasapara
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtera, India
| | - Vijay Shetty
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtera, India
| | - Ramachandra Gopinath
- Department of Cardiac Anesthesia, Nizam's Institute of Medical Sciences, Hyderabad, Telanagana, India; Department of Anesthesiology, ESIC Medical College and Super Speciality Hospital, Hyderabad, Telangana, India
| | - Archana Pathy
- Department of Cardiac Anesthesia, Nizam's Institute of Medical Sciences, Hyderabad, Telanagana, India
| | - V V Raja Viswanath
- Department of Cardiac Anesthesia, Citizen's Hospital, Hyderabad, Telangana, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Unmesh Takalkar
- Department of Surgery, United CIIGMA Hospital, Aurangabad, Maharashtra, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Murali Chakravarthy
- Department of Cardiac Anesthesia, Fortis Hospitals, Bengaluru, Karnataka, India
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