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Normal values of left-ventricular mass: echocardiographic findings from the PAMELA study

Cuspidi, Cesarea,b; Facchetti, Ritaa; Sala, Carlac; Bombelli, Michelea; Negri, Francescaa,b; Carugo, Stefanoc; Sega, Robertoa; Grassi, Guidoa,d; Mancia, Giuseppea

doi: 10.1097/HJH.0b013e328352ac39

Background and aim: Upper reference values of echocardiographic left-ventricular mass in the European population are based on scanty data mostly derived from northern European population-based samples. Furthermore, data in apparently healthy populations have included individuals with conditions affecting left-ventricular mass such as obesity, diabetes and masked hypertension. Thus, from 1051 individuals with normal office blood pressure (BP) belonging to the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study population, we selected a group of 675 sustained normotensive individuals in order to provide reliable echocardiographic reference values for defining the criteria of left-ventricular hypertrophy (LVH).

Methods: The study group (women 58%, mean age 42 ± 11 years) was identified after excluding individuals with isolated home or ambulatory hypertension, obesity, diabetes, cardiovascular diseases and echocardiographic examinations of insufficient quality to evaluate left-ventricular mass.

Results: Sex-specific upper limits of normality [mean + 1.96 standard deviation (SD)] for left-ventricular mass, left-ventricular mass indexed to body surface area, height2.7and height were the following: 213 g, 114 g/m2, 51 g/h2.7, 123 g/h in men and 161 g, 99 g/m2, 47 g/h2.7, 101 g/h in women. In multivariate analyses, body size measures and ambulatory BP levels were the most important correlates of left-ventricular mass.

Conclusions: Our investigation by providing upper reference limits of left-ventricular mass in a southern European population sample, carefully selected after exclusion of a large number of conditions affecting left-ventricular mass, may offer a contribution for revising diagnostic criteria of echocardiographic LVH currently recommended by European hypertension guidelines.

aDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca

bIstituto Auxologico Italiano IRCCS

cHeart and Lung Department, University of Milano and Fondazione Ospedale Maggiore Policlinico

dIstituto IRCCS Multimedica, Sesto san giovanni (Milan), Italy

Correspondence to Professor Cesare Cuspidi, Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy. Tel: +39 0362 772433; fax: +39 0362 772416; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; BSA, body surface area; IVS, interventricular septum thickness; LVH, left-ventricular hypertrophy; LVID, left-ventricular internal diameter; PAMELA, Pressioni Arteriose Monitorate E Loro Associazioni; PWT, posterior wall thickness

Received 17 October, 2011

Revised 27 December, 2011

Accepted 16 February, 2012

© 2012 Lippincott Williams & Wilkins, Inc.