https://doi.org/10.1007/s00392-025-02737-x
1Evangelisches Krankenhaus Oldenburg Klinik für Innere Medizin und internistische Intensivmedizin Oldenburg, Deutschland; 2Klinikum Oldenburg AöR Klinik für Kardiologie Oldenburg, Deutschland; 3Kinderkardiologische Praxis in Oldenburg Oldenburg, Deutschland; 4Institut für Herz-Kreislauf-Forschung Cloppenburg, Deutschland
Background:
Indexing echocardiographic measurements to body surface area (BSA) is a well-established method for adjusting an individuals values to a population-based standard. However, studies in pediatric populations have demonstrated a stronger correlation between echocardiographic parameters and height.
The aims of this study were to assess whether: (a) indexing to BSA continues to yield the strongest correlation with echocardiographic parameters compared to height and weight in adults, and (b) factors such as sex, type 2 diabetes mellitus (T2DM), and arterial hypertension (aHTN) influence these correlations.
Methods:
We retrospectively analyzed echocardiographic data collected at our institution between 2000 and 2017. Inclusion criteria were: adults, no structural heart disease (EF > 55%, no significant valvular defects, no acute illness). A total of 2,560 patients were included and stratified into three groups: “Healthy” (n = 1118), “Hypertension” (n = 1024), and “Diabetes + Hypertension” (n = 307). The primary focus was on the left ventricular end-diastolic diameter (LVEDD) and the aortic root diameter (AO), and their correlation with body weight, height, and BSA. Pearson’s correlation coefficient (r) was used for statistical analysis.
Results:
Among healthy females, AO showed the strongest correlation with BSA (r = 0.131, p = 0.023). In healthy males, the highest correlation was observed with body weight (r = 0.242, p < 0.001). LVEDD correlated most strongly with BSA in both healthy females (r = 0.249, p < 0.001) and healthy males (r = 0.243, p < 0.001).
When comparing across the three groups, women demonstrated the highest correlation coefficients in the AO/Diabetes + Hypertension group (r = 0.281, p = 0.004) and in the LVEDD/Hypertension group (r = 0.308, p < 0.001). In males, the strongest correlations were found in the healthy subgroups.
Implications for Research and Clinical Practice:
BSA remains the most reliable parameter for indexing echocardiographic measurements. Lifestyle-related diseases such as hypertension and type 2 diabetes do not significantly alter the correlation of LVEDD and aortic root diameter with body size in general, but the combination of type 2 diabetes and hypertension enhances the correlation between aortic root diameter and BSA in women. A similar correlation was observed for hypertension and LVEDD in females, but not in males. These findings suggest a potentially greater impact of cardiometabolic diseases on cardiovascular dimensions in women, warranting further research into sex-specific cardiac remodeling and the influence of metabolic conditions on cardiac structure.