Effect of Race on Echocardiographic Measures of Cardiac Structure and Function

The relations between race and cardiac structure and function are incompletely understood. We hypothesized that race-specific differences in echocardiography measurements exist. We compared the relation between echocardiography measurements and race among 12,429 nonobese adults without known cardiovascular disease who underwent echocardiography. We compared measurements between whites (n = 10,508), blacks (n = 792), Asians (n = 628), Hispanics (n = 315), Native Americans (n = 34), and multiracial/other (n = 152) cohorts. Multivariate analysis compared measurements indexed to body surface area (BSA) between races and adjusted for variables including age, gender, and mean blood pressure. Mean age was 46.9 ± 17.4 years and 60.5% were women. After multivariable adjustment and using whites as a baseline, there were significant differences (p <0.05) in left ventricular end-diastolic diameter/BSA for blacks (-0.5 mm/m²), Asians (0.4 mm/m²), Hispanics (0.2 mm/m²), and multiracial/others (0.1 mm/m²); septal wall thickness/BSA for blacks (0.4 mm/m²) and Asians (0.1 mm/m²); posterior wall thickness/BSA for blacks (0.4 mm/m²), Asians (0.1 mm/m²), Hispanics (0.04 mm/m²), and multiracial/others (0.03 mm/m²); left atrial diameter/BSA for Asians (0.2 mm/m²), Hispanics (0.3 mm/m²), and multiracial/others (0.1 mm/m²); septal and lateral e' for blacks (-0.7 cm/s; -0.9 cm/s); and peak tricuspid regurgitation gradient for blacks (4.3 mm Hg) and Asians (-0.9 mm Hg). Race is associated with significant differences in left ventricular size, left atrial size, mitral annular velocity, and tricuspid regurgitation gradient. Normal reference ranges for echocardiography measurements should utilize racially diverse cohorts to prevent misclassification of echocardiography findings based on race.