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Background: Continuous technologic development and updated recommendations for image acquisitions creates a need to update the current normal reference ranges for echocardiography. The best method of indexing cardiac volumes is unknown., Objectives: The authors used 2- and 3-dimensional echocardiographic data from a large cohort of healthy individuals to provide updated normal reference data for dimensions and volumes of the cardiac chambers as well as central Doppler measurements., Methods: In the fourth wave of the HUNT (Trøndelag Health) study in Norway 2,462 individuals underwent comprehensive echocardiography. Of these, 1,412 (55.8% women) were classified as normal and formed the basis for updated normal reference ranges. Volumetric measures were indexed to body surface area and height in powers of 1 to 3., Results: Normal reference data for echocardiographic dimensions, volumes, and Doppler measurements were presented according to sex and age. Left ventricular ejection fraction had lower normal limits of 50.8% for women and 49.6% for men. According to sex-specific age groups, the upper normal limits for left atrial end-systolic volume indexed to body surface area ranged from 44 mL/m 2 to 53 mL/m 2 , and the corresponding upper normal limit for right ventricular basal dimension ranged from 43 mm to 53 mm. Indexing to height raised to the power of 3 accounted for more of the variation between sexes than indexing to body surface area., Conclusions: The authors present updated normal reference values for a wide range of echocardiographic measures of both left- and right-side ventricular and atrial size and function from a large healthy population with a wide age-span. The higher upper normal limits for left atrial volume and right ventricular dimension highlight the importance of updating reference ranges accordingly following refinement of echocardiographic methods., Competing Interests: Funding Support and Author Disclosures This study was funded by the Liaison Committee for Education, Research, and Innovation in Central Norway and grants from the Simon Fougner Hartmann Family Fund, Denmark. Drs Grue, Olaisen, Løvstakken, and Dalen hold positions at the Center for Innovative Ultrasound Solutions, where GE Ultrasound is one of the institutional partners. Dr Løvstakken is a part-time consultant for GE Ultrasound. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Investigate variability related to image acquisition and reading process for echocardiographic measures of left ventricular (LV) diastolic function, and its influence on classification of LV diastolic dysfunction (LVDD)., Methods: Forty participants (19 women) mean age 62 (28-88) years underwent echocardiographic examinations twice by different echocardiographers and blinded analyses by four readers in a cross-sectional design. Measurements included quantification of two- (2D) and three-dimensional (3D) recordings of the left atrium (LA) (maximal) volume (LAV max ) and spectral Doppler blood flow and tissue velocities for assessment of LV diastolic function. Variability and reproducibility measures were calculated using variance component analyses and Kappa statistics., Results: Image acquisition influenced variability more than image reading (mean 24% and 4% of variance, respectively), but variability from image reading was especially important for 2D LAV max (16% of variance) compared to 4% for 3D LAV max , which was reflected in better agreement for 3D measures. The variability of measures used in classification of LVDD had clinical significance, and agreement across the four raters in classification using current recommendations was only fair (Kappa 0.42), but the agreement improved when using 3D LAV max (Kappa 0.58). Agreement and reliability measures were reported for all measures., Conclusion: Performing a new image acquisition influenced variability more than a introducing a new image reader, but there were differences across the different measures. LAV max by 3D is superior to 2D with respect to lower variability. The variability of diastolic measures influences the reliability of LVDD classification, and this should be taken into account in the everyday clinic., (© 2021 The Authors.Echocardiography published by Wiley Periodicals LLC.)

Background Left atrial (LA) size and cardiorespiratory fitness (CRF) are predictors of future cardiovascular events in high-risk populations. LA dilatation is a diagnostic criterion for left ventricular diastolic dysfunction. However, LA is dilated in endurance athletes with high CRF, but little is known about the association between CRF and LA size in healthy, free-living individuals. We hypothesized that in a healthy population, LA size was associated with CRF and leisure-time physical activity, but not with echocardiographic indexes of left ventricular diastolic dysfunction. Methods and Results In this cross-sectional study from HUNT (Nord-Trøndelag Health Study), 107 men and 138 women, aged 20 to 82 years, without hypertension, cardiovascular, pulmonary, or malignant disease participated. LA volume was assessed by echocardiography and indexed to body surface area LAVI (left atrial volume index). CRF was measured as peak oxygen uptake (VO 2peak ) using ergospirometry, and percent of age- and-sex-predicted VO 2peak was calculated. Indexes of left ventricular diastolic dysfunction were assessed in accordance with latest recommendations. LAVI was >34 mL/m 2 in 39% of participants, and LAVI was positively associated with VO 2peak and percentage of age- and-sex-predicted VO 2peak (β [95% CI], 0.11 [0.06-0.16] and 0.18 [0.09-0.28], respectively) and weighted minutes of physical activity per week (β [95% CI], 0.01 [0.003-0.015]). LAVI was not associated with other indexes of left ventricular diastolic dysfunction. There was an effect modification between age and VO 2peak /percentage of age- and-sex-predicted VO 2peak showing higher LAVI with advanced age and higher VO 2peak /percentage of age- and-sex-predicted VO 2peak as presented in prediction diagrams. Conclusions Interpretation of LAVI as a marker of diastolic dysfunction should be done in relation to age-relative CRF. Studies on the prognostic value of LAVI in fit subpopulations are needed.

Background: Oral tobacco (snuff) is taking a large market share in Scandinavia, especially with young users. However, long-term health effects are unknown. Small studies show association between snuff and reduced endothelial function, representing an early stage of vascular injury that often precedes manifest cardiovascular disease by several years. We therefore determined the associations between snuff and endothelial function in a large sample of healthy Norwegian men., Methods and Design: In the Fitness substudy of the Nord-Trøndelag Health Study (HUNT3), endothelial function was measured by flow-mediated dilation (FMD). Aerobic fitness was measured by peak oxygen uptake (VO2peak). A cross-sectional design including 1 592 self-reported healthy men compared these observations with records of present tobacco use, standard cardiovascular risk factors, and socioeconomic status, using general linear models., Results: FMD was lower in snuff users (FMD: 4.12%, 3.63, 4.61) compared to non-users (FMD: 4.52%, 4.27, 4.78) after adjustment for age (difference: -0.57%, -1.12, -0.01). After further adjustment for potential confounders, FMD still tended to be lower in snuff users than in non-users (difference: -0.53%, -1.09, 0.02). This difference was even more pronounced in the inactive snuff users (-0.83%, -1.59, -0.06) and in the low fit snuff users (-0.74%, CI -0.55, 0.079)., Conclusions: Oral tobacco is associated with a tendency towards reduced endothelial function, indicating vascular changes that precede cardiovascular disease. The strongest associations were found in men with low physical activity or reduced aerobic fitness.