Original Article

Journal of Human Hypertension (2012) 26, 420–429; doi:10.1038/jhh.2011.56; published online 2 June 2011

Geographic variation in left ventricular mass and mass index: a systematic review

K K Poppe1,2, M Edgerton Bachmann1, C M Triggs2, R N Doughty1 and G A Whalley1,3

  1. 1Department of Medicine, The University of Auckland, Auckland, New Zealand
  2. 2Department of Statistics, The University of Auckland, Auckland, New Zealand
  3. 3Faculty of Social and Health Sciences, Unitec, Auckland, New Zealand

Correspondence: KK Poppe, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. E-mail: k.poppe@auckland.ac.nz

Received 21 October 2010; Revised 7 April 2011; Accepted 3 May 2011
Advance online publication 2 June 2011



Left ventricular (LV) hypertrophy, defined as an abnormal increase in LV mass (LVM), is an important prognostic indicator and therapeutic target. LVM is often divided by body surface area to derive indexed mass; however, this does not correctly identify pathological LV hypertrophy in all people, especially when body composition is altered, or in different ethnic groups. We evaluated published ranges of echocardiographic LVM in healthy adult populations from different countries, excluding control groups, and compared them with the American Society of Echocardiography reference ranges. A total of 33 studies met the inclusion criteria. In men and women, there was wide variation in the ranges of LVM with a tendency for the upper limit to increase geographically westward; this variation remained for indexed mass. Several ranges fell outside the upper reference limits: in men, 13 of the mass ranges and 16 of indexed mass; and in women, 8 mass and 16 indexed mass. This review has shown that current guidelines may need revision as some published series suggest that greater LV mass should be considered normal. This may be explained by ethnic differences and supports the need for widely applicable and ethnically diverse reference ranges to be established.


systematic review; echocardiography; left ventricular hypertrophy; lean body mass

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