Effect of sex, age and body measurements on heart weight, atrial, ventricular, valvular and subepicardial fat measurements of the normal heart.

AIMS: Descriptive morphological studies of the normal heart are lacking. Previous autopsy studies have focussed mainly on heart weight. We characterise the normal heart by providing normal dimensions of the atria, ventricles, valves and subepicardial fat, comparing the findings in terms of sex, age and body measurements.

METHODS: From 3602 referrals to our cardiovascular pathology unit, pathological criteria used for the classification of a morphologically normal heart were a weight of below 500 grams in males, and below 400 grams in females. Diseased hearts were excluded on anatomical and histological evaluation.

RESULTS: We diagnosed 1062 morphologically normal hearts. Mean age at death was 34±12, with a male predominance (701, 66%). Age was similar in females and males (35±13 vs 34±12). Females had a significantly lower heart weight (285±55 vs 374±64). Sex was an independent predictor of most measurements. The atrial and ventricular cavities were significantly larger in males. All ventricular measurements of muscle thickness were larger in males. All valvular circumferences were larger in males. In contrast, subepicardial fat was significantly thicker in females in 6 of 7 regions. This is the first study to provide a calculator to give expected values according to sex, age, height and weight.

CONCLUSIONS: Major differences between the sexes exist in the morphologically normal heart. These variations should be considered when assessing cardiac structure in imaging for risk stratification and diagnosis in the cardiomyopathies, as well as in treatment outcomes.