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(Circulation. 2008;117:2279-2287.)
© 2008 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Does Size Matter?

Clinical Applications of Scaling Cardiac Size and Function for Body Size

Frederick E. Dewey, BA; David Rosenthal, MD; Daniel J. Murphy, Jr, MD; Victor F. Froelicher, MD; Euan A. Ashley, MRCP, DPhil

From the Division of Cardiovascular Medicine (F.E.D., V.F.F., E.A.A.) and the Division of Pediatric Cardiology (D.R., D.J.M.), Stanford University School of Medicine, Stanford, Calif.

Correspondence to Dr Euan Ashley, Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, 300 Pasteur Dr, Stanford, CA 94305. E-mail euan{at}stanford.edu

Extensive evidence is available that cardiovascular structure and function, along with other biological properties that span the range of organism size and speciation, scale with body size. Although appreciation of such factors is commonplace in pediatrics, cardiovascular measurements in the adult population, with similarly wide variation in body size, are rarely corrected for body size. In this review, we describe the critical role of body size measurements in cardiovascular medicine. Using examples, we illustrate the confounding effects of body size. Current cardiovascular scaling practices are reviewed, as are limitations and alternative relationships between body and cardiovascular dimensions. The experimental evidence, theoretical basis, and clinical application of scaling of various functional parameters are presented. Appropriately scaled parameters aid diagnostic and therapeutic decision making in specific disease states such as hypertrophic cardiomyopathy and congestive heart failure. Large-scale studies in clinical populations are needed to define normative relationships for this purpose. Lack of appropriate consideration of body size in the evaluation of cardiovascular structure and function may adversely affect recognition and treatment of cardiovascular disease states in the adult patient.

Key Words: cardiomyopathy • hypertrophy • body size • organ size

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