J Vet Intern Med 2004;18:311–321

Allometric Scaling of M-Mode Cardiac Measurements in Normal

Adult Dogs
Craig C. Cornell, Mark D. Kittleson, Paul Della Torre, Jens Häggström, Christophe W. Lombard,
Henrik D. Pedersen, Andrea Vollmar, and Aaron Wey

Indices for M-mode measurements in dogs usually have been based on the assumption that a linear relationship exists between
these measurements and body weight (BW) or body surface area (BSA). The relationships between the geometry of 3-dimensional
objects do not support this assumption. The purposes of this study were to retrospectively examine M-mode data from a large
number of dogs of varying sizes and breeds that were examined by a large number of ultrasonographers, to use the allometric
equation to determine the appropriate BW exponent required to predict these cardiac dimensions, and to determine normal mean
values and prediction intervals for common M-mode variables. Linear regression analyses of data from 494 dogs (2.2–95 kg)
revealed a good correlation between M-mode measurements and BW after logarithmic transformation of the data (r2 5 .55–.88).
Most variables were most closely related to an index of body length, BW1/3, although the exponent that best predicted diastolic
and systolic left ventricular wall thicknesses was closer to 0.25. No variable indexed well to BW or BSA. With these data,
appropriate mean values and prediction intervals were calculated for normal dogs, allowing veterinarians to correctly and appro-
priately index M-mode values. The equations developed from this study appear to be applicable to adult dogs of most breeds.
Key words: Canine; Echocardiography; Heart; Reference range.

M -mode echocardiography is commonly used to mea-

sure linear cardiac dimensions of cardiac chambers,
walls, and great vessels. Because adult dogs range in weight
from ,2 to .90 kg, any definition of normal heart size
must take into account the variation caused by differences
in body size. Consequently, it is important to identify equa-
tions that accurately describe the relationships between
body size and cardiac dimensions. Several authors have
published equations, nomograms, or tables that are intended
to be used as reference ranges for M-mode measurements
for adult dogs of varying size and breed.1–11 Critics have
questioned the usefulness of some of these reference ranges
because of small sample sizes, lack of data points for the
extremes of body size, wide prediction intervals, and the
use of inappropriate statistical methods.5,10–15 In addition,
many authors have assumed that a linear relationship exists
between linear cardiac dimensions and either body weight
(BW) or body surface area (BSA), which might not be true.
Evidence also has been presented suggesting that a general
equation might never be accurate because breed is a factor
From the Veterinary Medical Teaching Hospital (Cornell, Wey) and
the Department of Medicine and Epidemiology, School of Veterinary
Medicine (Kittleson), University of California, Davis, CA; the Univer-
sity Veterinary Centre–Faculty of Veterinary Science, University of
Sydney, Sydney, Australia (Della Torre); the University of Agricultural
Sciences, Uppsala, Sweden (Häggström); the University of Berne,
Berne, Switzerland (Lombard); The Royal Veterinary and Agricultural
University, Frederiksberg, Denmark (Pedersen); and the Small Animal
Veterinary Hospital of Wissen, Wissen, Germany (Vollmar). Dr Wey
is currently affiliated with Upstate Veterinary Specialties, PLLC, La-
tham, NY. The results of this study were presented at the European
Society of Veterinary Internal Medicine 2001 Congress, Dublin, Ire-
land, on September 9, 2001. An abstract was printed in the proceed-
ings for this meeting.
Reprint requests: Craig Cornell, Veterinary Medical Teaching Hos-
pital, University of California, Davis, One Shields Avenue, Davis, CA
95616-8747; e-mail: cccornell@ucdavis.edu.
Submitted March 7, 2003; Revised July 1 and October 31, 2003;
Accepted December 11, 2003.
Copyright q 2004 by the American College of Veterinary Internal
Medicine
0891-6640/04/1803-0009/$3.00/0
that can cause M-mode measurements in dogs of the same
weight to differ.13
The statistical methods used to produce the previously
mentioned reference ranges were not described in every
case, but in 2 studies in which the authors detailed their
methods, reference ranges were calculated by linear regres-
sion to fit a straight line to data consisting of M-mode di-
mensions and BSA in 1 study and M-mode dimensions and
BW in the other.1,2 In order for this technique to be accurate,
the relationship between BW or BSA and diameter or thick-
ness measured by M-mode echocardiography must be lin-
ear, or the data should be transformed to produce a linear
relationship.16,17
Logic dictates that cardiac volumes (eg, left ventricular
end diastolic volume) should be linearly related to BW
(volume), whereas cross-sectional areas within the heart
(eg, aortic root cross-sectional area) should relate linearly
to BSA (proportional to BW2/3) and cardiac linear dimen-
sions, such as chamber diameters and wall thicknesses,
should be linearly related to body length (proportional to
BW1/3). If this logic is correct, then the use of BSA or BW
to predict linear cardiac dimensions is incorrect. A large
sample size of dogs with a large range in BW is needed to
identify the correct relationship between linear cardiac di-
mensions and some exponent of BW. Once these require-
ments are met, the allometric equation Y 5 aM b can be
used to fit a straight line to the relationship and identify the
correct exponent for BW. In this equation, Y represents a
measure of heart size (volume, area, or linear dimension),
M is BW, and a and b are constants. The constants are
sometimes referred to as the proportionality constant (a)
and the scaling exponent (b). The logarithmic form of the
allometric equation
log(Y) 5 log(a) 1 b log(M) (1)
is a linear equation. The exponent b in the allometric equa-
tion is predictable when using weight to calculate other
dimensions in geometrically similar objects, such as cubes.
As outlined above, volume is aM1, surface area is aM2/3,
and length is aM1/3.18–20 Even though animals are not geo-
metrically similar, they often follow the same pattern. End
312 Cornell et al

Table 1. Sample populations compiled for use in this study. Numbers represent the number of dogs from which each M-
mode variable was obtained.
Sonographer
and Reference Breed LVIDd LVIDs LVWd LVWs IVSTd IVSTs Ao LA HR
De Madrone, 1983 32
Unknown 27 27 27 27 27 27 27 27
Della Torre, personal
communication Greyhounda 20 20 20 20 20 20 20
Della Torre, personal
communication Whippeta 20 20 20 20 20 20 20
Della Torre, personal Italian Grey-
communication hounda 20 20 20 20 20 20 20
Gooding et al, 198631 English Cocker
Spaniel 12 12 12 12
Haggstrom, personal
communication CKCS 57 57 57 57 57 57
Lombard, personal com-
munication Unknown 23 23 23 23 23 23
Mashiro et al, 197633 Mixed 16 16 16 16 16
Pedersen, personal com-
munication Dachshund 33 33 33 33 33 33 33 33
Vollmar, personal com-
munication Boxer 75 75 75 75 75 75 75 75 75
Vollmar, personal com-
munication Irish Wolfhound 144 144 144 144 144 144 144 144 144
Wey, personal communi-
cation Mixed 47 47 47 47 47 47 47
Total 494 494 494 386 414 386 359 359 422

CKCS, Cavalier King Charles Spaniels; LVIDd, left ventricular end diastolic diameter; LVIDs, left ventricular end systolic diameter; LVWd, left
ventricular free wall thickness in diastole; LVWs, left ventricular free wall thickness in systole; IVSTd, interventricular septal thickness in diastole;
IVSTs, interventricular septal thickness in systole; Ao, aortic root diameter; LA, left atrial diameter; HR, heart.
a
Sedated.

diastolic, end systolic, and stroke volumes are predicted by
aM1, BSA and aortic valve area are predicted by aM 2/3, and
the diameter of the aorta is predicted by aM1/3.15,21–25 The
use of allometric scaling in echocardiography has been re-
viewed, and the use of this technique in dogs also has been
discussed previously.26,27 The allometric equation has been
used previously with BW to predict linear M-mode mea-
surements in people, dogs, and rhesus monkeys.15,27–30 The
exponents of the allometric equations from these studies are
closer to the theoretical value of ⅓ than the exponents ⅔
or 1.15,27–30
The 1st objective of this study was to fit the allometric
equation to retrospectively collected data from a large sam-
ple of dogs of different breeds and widely varying body
size to determine the correct scaling exponent (b) in the
allometric equation Y 5 a Mb for predicting normal M-mode
measurements in adult dogs. The 2nd objective was to cal-
culate the 95% prediction interval for these data for various
M-mode measurements in normal adult dogs.
Materials and Methods
Dogs
Data were gathered retrospectively from a sample group of 494 dogs
comprising 33 Dachshunds, 57 Cavalier King Charles Spaniels, 20
Italian Greyhounds, 12 English Cocker Spaniels, 20 Whippets, 20
Greyhounds, 75 Boxer dogs, 144 Irish Wolfhounds, and 113 dogs of
mixed or unknown breed. These dogs were examined by 9 investi-
gators, and some of the data were reported in 12 separate studies
(Table 1). The dogs ranged in weight from 2.2 to 95 kg. All dogs were
clinically normal adults of either sex. Sixty of the dogs (Greyhounds,
Whippets, and Italian Greyhounds) were sedated with a combination
of acepromazine (0.03 mg/kg SQ) and morphine (0.5 mg/kg SQ).
M-Mode Measurements
M-mode measurements made by the 9 sonographers were collected
from published data or from unpublished data provided by the inves-
tigator for this study (Paul Della Torre, Jens Häggström, Christophe
W. Lombard, Henrik D. Pedersen, Andrea Vollmar, Aaron Wey, per-
sonal communication).31–33 Body weight and measurements of left ven-
tricular end diastolic diameter (LVIDd), left ventricular end systolic
diameter (LVIDs), and left ventricular free wall thickness in diastole
(LVWd) were compiled from all 494 normal dogs. In addition, left
atrial (LA) and aortic root (Ao) dimensions were measured in 359 of
these dogs. Interventricular septal thickness in diastole (IVSTd) was
measured in 414 dogs, whereas measurements of interventricular sep-
tal thickness in systole (IVSTs) and left ventricular free wall thickness
in systole (LVWs) were made in 386 dogs. Measurements of left atrial
diameter all were made by the M-mode technique, in which the cursor
was passed through the widest region of the root of the aorta and so
passed through either the cranial body of the left atrium or the caudal
portion of the left auricle. In addition to the measured values, frac-
tional shortening (FS), the ratio of left atrial to aortic root diameter
(LA : Ao), and the ratio of left ventricular diameter to left ventricular
free wall thickness (LVIDd : LVWd) were calculated for 494 dogs. De-
tails of the methods used to obtain the data have been published pre-
viously in most cases.5,31–36
Data Analysis
Linear regression analyses were performed after logarithmic trans-
formation of the data.a,b The slope of the regression line gives the
 M-Mode Values in Dogs
Fig 1. Left ventricular end diastolic diameter (LVIDd) versus body
weight after logarithmic transformation. The regression line and the
95% prediction interval are shown for this variable. Note that the re-
lationship between the log of body weight and the log of LVIDd is
linear.
constant b in the allometric equation, and the antilogarithm (log21) of
the intercept of the line gives the constant a (Equation 1). The 95%
prediction intervals that appear in Figures 1–4 were calculated by
Equation 2.17
!
1 (x 2 X) 2
Yc 6 tSx,y 1 1 1
n O (xi 2 X) 2
(2)
Yc is the calculated value of Y for a given value of x, t is the Student’s
t value for n 2 2 degrees of freedom, n is the number of data points,
Sx,y is the standard error of the estimate, X is the mean of the individual
x values, S (xi 2 X)2 is the sum of the squared deviations of the sample
mean.
Because calculating the prediction intervals by Equation 2 is rather
complex, a simpler method of calculating the 2.5, 5, 25, 50, 75, 90,
and 97.5% limits of the prediction interval also has been included
(Equation 3). When the sample size is large, the prediction intervals
calculated by Equations 2 and 3 will be almost the same.37
constant 5 log21[log(a) 6 tSx,y] (3)
The t is the Student’s t value for n 2 2 degrees of freedom and the
desired degree of confidence, Sx,y is the standard error of the estimate,
and log(a) is a constant determined by regression analysis.
In order to examine the effect of heart rate (HR) on LVIDd and
LVIDs, multiple regression analysis with log(BW) and log(HR) as pre-
dictor variables was performed. The percentiles for FS, LA : Ao, and
LVIDd : LVWd were calculated by sorting the 494 values in ascending
order. The lowest value was given a rank of 1 and the largest value a
rank of 494. The percentile for each value was calculated by percentile
Fig 2. Left ventricular end diastolic diameter (LVIDd) versus body
weight (kg) showing the regression line and the 95% prediction inter-
val for this variable. Note the curvilinear relationship.
313
Fig 3. Left ventricular end diastolic diameter (LVIDd) versus body
surface area showing the regression line and the 95% prediction in-
terval for this variable. Note the relationship is still curvilinear.
5 100(rank 2 0.5)/494. The values for FS, LA : Ao, and LVIDd :
LVWd at 2.5, 5, 25, 50, 75, 90, and 97.5 percentile limits were read
from the list of percentile values.
Previously published breed-specific LVIDd measurements from 23
groups of dogs were used to show the effect of the different methods
used to normalize M-mode measurements.13,27,29,38–48
Results
Logarithmically transformed M-mode measurements and
BW were significantly correlated (P , .001 for all vari-
ables). Correlation was highest for end diastolic and end
systolic diameters of the left ventricular chamber, aortic di-
ameter, and left atrial diameter (r2 5 .88, .77, .88, and .83,
respectively). The constant b in the allometric equation was
close to the theoretical value of ⅓ for most of the variables.
In the case of Ao, LA, and LVIDs, the value ⅓ fell within
the 95% confidence interval for the exponent, whereas that
for LVIDd was slightly lower than ⅓ (Table 2). The expo-
nent for the left ventricular wall thicknesses in systole and
diastole, however, appeared to be closer to 0.25. The cor-
relation coefficients for FS, LA : Ao, LVIDd : LVWd, and
BW were calculated. No significant correlation was found
between FS or LA : Ao and BW. A weak but statistically
significant correlation was found between LVIDd : LVWd
and BW (r2 5 .23, P , .001). It is possible to anticipate
this correlation by examining the equations for LVIDd and
Fig 4. Left ventricular end diastolic diameter (LVIDd) versus body
weight (BW)1/3 showing the regression line and the 95% prediction
interval for this variable. Note the relationship is linear.
314 Cornell et al

Table 2. Results of regression analyses.

M-mode Std Error No. of Std Error
Measurement log(a) a of Y Est r2 Observations b of b
LVIDd 0.185 1.53 0.042 0.874 494 0.294 0.005
LVIDs 20.024 0.95 0.063 0.777 494 0.315 0.008
LVWd 20.377 0.42 0.078 0.551 494 0.232 0.009
LVWs 20.192 0.64 0.066 0.612 386 0.222 0.009
IVSTd 20.385 0.41 0.078 0.564 414 0.241 0.010
IVSTs 20.235 0.58 0.067 0.645 386 0.240 0.009
Ao 20.110 0.78 0.046 0.879 359 0.341 0.007
LA 20.122 0.76 0.056 0.834 359 0.345 0.008

LVIDd, left ventricular end diastolic diameter; LVIDs, left ventricular end systolic diameter; LVWd, left ventricular free wall thickness in
diastole; LVWs, left ventricular free wall thickness in systole; IVSTd, interventricular septal thickness in diastole; IVSTs, interventricular septal
thickness in systole; Ao, aortic root diameter; LA, left atrial diameter.

LVWd. The exponents in these equations differ enough to
cause an observable change in LVIDd : LVWd as BW changes.
Multiple regression with log(BW) and log(HR) as pre-
dictor variables only resulted in a modest improvement in r 2.
LVIDd 5 2.31 3 BW0.298 3 HR20.092
r 2 5 .89, Sx,y 5 0.0384
LVIDs 5 1.97 3 BW0.328 3 HR20.167
r 5 .79, Sx,y 5 0.0598
2
The log transformation of LVIDd versus BW and plots
of LVIDd versus BW, BSA, and BW1/3 are shown in Figures
1–4. Lines are drawn on these plots to indicate the regres-
sion line and the boundaries of the 95% prediction intervals
for this variable. Table 3 shows the constants for the pre-
diction intervals. These constants were calculated by Equa-
tion 3 and can be used to reconstruct the prediction inter-
vals shown in the plots or to calculate the range of normal
values for dogs of any weight. For example, the LVIDd for
95% of 20-kg dogs would be expected to be between 1.27
3 200.294 5 3.1 cm and 1.85 3 200.294 5 4.5 cm. Table 4
shows the mean values and 95% prediction intervals for
various M-mode measurements for dogs of different
weights.
The equations developed from the regression analyses
can be used to normalize M-mode measurements. The al-
lometric equation can be rearranged to give proportionality
constant a 5 Y/Mb. If Y is an M-mode measurement and
Mb is BW raised to the b power, a will be a constant that
is the normalized or indexed M-mode measurement. This
approach has been employed previously with equations
similar to those developed in this study.49 If an M-mode
measurement is divided by BW raised to the power shown
in the exponent column of Table 3, the result is the nor-
malized or indexed value. This value can be compared with
the constants in the table to determine whether it is within
the normal range. For example, to determine whether 3.3
cm is a normal LVIDd for a 10-kg dog, divide 3.3 by 100.294.
If the result is between 1.27 and 1.85, the value is within
the normal prediction interval for this study. In this ex-
ample, the result is 1.68. Table 5 shows comparisons of the
ratios of LVIDd : BW, LVIDd : BSA, and LVIDd : BW1/3 that
have been calculated with mean or median values of LVIDd
for groups of different breeds of dogs that were examined
in several studies.13,27,38–48 Comparing the ratios of the
smallest breed, the Miniature Poodle, with the ratios of the
giant breed dogs shows that there is almost an 8-fold dif-
ference in LVIDd : BW and a 3-fold difference in LVIDd :
BSA, but the ratio of LVIDd to the cube root of BW is
nearly constant.
Table 6 shows the normal range of percent FS, LA : Ao,
and LVIDd : LVWd for dogs in this study. The ratio LVIDd :
LVWd occasionally is used to evaluate the left ventricular
response to stress.15,38,50–52 Figures 5–7 show cumulative
percentage plots of these ratios. Approximately 95% of the
dogs in this study had FS between 23 and 47%, and 95%
had FS . 25%. In the 494 animals examined in this study,

Table 3. Constants for indexing M-mode variables and calculating prediction intervals.
97.5 95 75 50 25 5 2.5
Measurement Percentile Percentile Percentile Percentile Percentile Percentile Percentile Exponent
LVIDd 1.85 1.73 1.63 1.53 1.43 1.35 1.27 0.294
LVIDs 1.26 1.14 1.05 0.95 0.86 0.79 0.71 0.315
LVWd 0.60 0.53 0.47 0.42 0.37 0.33 0.29 0.232
LVWs 0.87 0.78 0.71 0.64 0.58 0.53 0.48 0.222
IVSTd 0.59 0.52 0.46 0.41 0.36 0.33 0.29 0.241
IVSTs 0.79 0.71 0.64 0.58 0.52 0.48 0.43 0.240
Ao 0.96 0.89 0.84 0.78 0.73 0.68 0.63 0.341
LA 0.97 0.90 0.83 0.76 0.70 0.64 0.59 0.345

LVIDd, left ventricular end diastolic diameter; LVIDs, left ventricular end systolic diameter; LVWd, left ventricular free wall thickness in
diastole; LVWs, left ventricular free wall thickness in systole; IVSTd, interventricular septal thickness in diastole; IVSTs, interventricular septal
thickness in systole; Ao, aortic root diameter; LA, left atrial diameter.
 M-Mode Values in Dogs 315

Table 4. Normal M-mode average values and prediction intervals for dogs of varying weights.a
Body wt.
(kg) LVIDd LVIDs LVWd LVWs IVSTd IVSTs Ao LA
3 2.1 1.3 0.5 0.8 0.5 0.8 1.1 1.1
1.8–2.6 1.0–1.8 0.4–0.8 0.6–1.1 0.4–0.8 0.6–1.0 0.9–1.4 0.9–1.4
4 2.3 1.5 0.6 0.9 0.6 0.8 1.3 1.2
1.9–2.8 1.1–1.9 0.4–0.8 0.7–1.2 0.4–0.8 0.6–1.1 1.0–1.5 1.0–1.6
6 2.6 1.7 0.6 1.0 0.6 0.9 1.4 1.4
2.2–3.1 1.2–2.2 0.4–0.9 0.7–1.3 0.4–0.9 0.7–1.2 1.2–1.8 1.1–1.8
9 2.9 1.9 0.7 1.0 0.7 1.0 1.7 1.6
2.4–3.4 1.4–2.5 0.5–1.0 0.8–1.4 0.5–1.0 0.7–1.3 1.3–2.0 1.3–2.1
11 3.1 2.0 0.7 1.1 0.7 1.0 1.8 1.7
2.6–3.7 1.5–2.7 0.5–1.0 0.8–1.5 0.5–1.1 0.8–1.4 1.4–2.2 1.3–2.2
15 3.4 2.2 0.8 1.2 0.8 1.1 2.0 1.9
2.8–4.1 1.7–3.0 0.5–1.1 0.9–1.6 0.6–1.1 0.8–1.5 1.6–2.4 1.6–2.5
20 3.7 2.4 0.8 1.2 0.8 1.2 2.2 2.1
3.1–4.5 1.8–3.2 0.6–1.2 0.9–1.7 0.6–1.2 0.9–1.6 1.7–2.7 1.7–2.7
25 3.9 2.6 0.9 1.3 0.9 1.3 2.3 2.3
3.3–4.8 2.0–3.5 0.6–1.3 1.0–1.8 0.6–1.3 0.9–1.7 1.9–2.9 1.8–2.9
30 4.2 2.8 0.9 1.4 0.9 1.3 2.5 2.5
3.5–5.0 2.1–3.7 0.6–1.3 1.0–1.9 0.7–1.3 1.0–1.8 2.0–3.1 1.9–3.1
35 4.4 2.9 1.0 1.4 1.0 1.4 2.6 2.6
3.6–5.3 2.2–3.9 0.7–1.4 1.1–1.9 0.7–1.4 1.0–1.9 2.1–3.2 2.0–3.3
40 4.5 3.0 1.0 1.5 1.0 1.4 2.7 2.7
3.8–5.5 2.3–4.0 0.7–1.4 1.1–2.0 0.7–1.4 1.0–1.9 2.2–3.4 2.1–3.5
50 4.8 3.3 1.0 1.5 1.1 1.5 3.0 2.9
4.0–5.8 2.4–4.3 0.7–1.5 1.1–2.1 0.7–1.5 1.1–2.0 2.4-3.6 2.3–3.7
60 5.1 3.5 1.1 1.6 1.1 1.5 3.2 3.1
4.2–6.2 2.6–4.6 0.7–1.6 1.2–2.2 0.8–1.6 1.1–2.1 2.5–3.9 2.4–4.0
70 5.3 3.6 1.1 1.6 1.1 1.6 3.3 3.3
4.4–6.5 2.7–4.8 0.8–1.6 1.2–2.2 0.8–1.6 1.2–2.2 2.7–4.1 2.6–4.2

LVIDd, left ventricular end diastolic diameter; LVIDs, left ventricular end systolic diameter; LVWd, left ventricular free wall thickness in
diastole; LVWs, left ventricular free wall thickness in systole; IVSTd, interventricular septal thickness in diastole; IVSTs, interventricular septal
thickness in systole; Ao, aortic root diameter; LA, left atrial diameter.
a
Mean and 95% prediction interval (cm).

Table 5. A comparison of different methods for normalizing M-mode measurements from previous studies.
Breed LVIDd:BW LVIDd:BSA LVIDd:BW1/3 Reference
Afghan Hounds 0.18 5.19 1.48 Morrison et al, 199213
Alaskan Sled Dogs 0.19 5.35 1.53 Stepien et al, 199818
Beagles, female 0.31 6.29 1.30 Crippa et al,, 199239
Beagles, male 0.28 5.91 1.24 Crippa et al,, 199239
Beagles, female 0.34 6.79 1.35 Hanton et al, 199840
Beagles, female 0.29 6.34 1.37 Hanton et al, 199840
Beagles, male 0.28 6.09 1.33 Hanton et al, 199840
Beagles, male 0.25 5.79 1.34 Hanton et al, 199840
Boxers 0.14 4.34 1.32 Herrtage, 199441
Deerhounds 0.12 4.29 1.48 Vollmar, 199842
Doberman Pinschers 0.13 4.29 1.42 Calvert and Brown, 198643
Doberman Pinschers 0.12 3.97 1.32 Sottiaux and Amberger, 199744
English Pointers 0.20 5.47 1.46 Sisson and Schaeffer, 199127
Golden Retrievers 0.14 4.46 1.42 Morrison et al, 199213
Great Danes 0.09 3.38 1.34 Koch et al, 199645
Greyhounds 0.17 4.95 1.48 Page et al, 199346
Greyhounds 0.16 4.96 1.52 Snyder et al, 199547
Irish Wolfhounds 0.07 2.99 1.22 Koch et al, 199645
Miniature Poodles 0.67 9.61 1.39 Morrison et al, 199213
Newfoundlands 0.08 3.23 1.27 Koch et al, 199645
Pembroke Corgis 0.21 5.26 1.30 Morrison et al, 199213
Spanish Mastiffs 0.09 3.41 1.28 Bayón et al, 199429
West Highland White Terriers 0.29 6.11 1.29 Baade et al, 200248

BSA, body surface area; BW, body weight; LVIDd, left ventricular end diastolic diameter.
316
Table 6. Prediction intervals for M-mode calculations.
97.5 95 75
Ratio Percentile Percentile Percentile
%FS 47 44 36
LA:Ao 1.3 1.3 1.1
LVIDd:LVWd 6.7 6.3 5.1
FS, fractional shortening; LA, left atrial diameter; Ao, aortic root diameter; LVIDd, left ventricular end diastolic diameter; LVWd, left ventricular
free wall thickness in diastole; ns, not significant.
a
An asterisk (*) denotes significance (P , .001).
FS ranged from 18 to 59%, with an approximately normal
distribution. However, in the 20 dogs with FS , 25%,
Greyhounds were disproportionately represented (9 Grey-
hounds, 3 Dachshunds, 1 Cavalier King Charles Spaniel,
and 7 mixed or unknown breeds). The weights of dogs with
the lowest values of fractional shortening were evenly dis-
tributed over a wide range (3.8–39 kg; mean 5 23.1 kg),
but the 21 dogs with FS . 45% tended to be small (2.6–
34.6 kg; mean 5 8.5 kg), with 17 of the dogs weighing
,10 kg. The upper limit of the 95% prediction interval for
LA : Ao was 1.3.
Despite the consistency between the predictions pro-
duced by this model and published breed-specific reference
ranges, we have noted that LVIDd never exceeded 6.0 cm
and LVIDs never exceeded 4.3 cm in any dog in this study.
The statistical analysis predicts that some dogs weighing
.60 kg could have values higher than this, but because
only 12 dogs weighed .75 kg, data to demonstrate this
prediction is lacking, and it is possible that prediction in-
tervals cannot be relied on in the larger dogs.
Discussion
The results of this study show that linear M-mode di-
mensions are normalized by dividing the measurement by
BW raised to a power in the range of 0.22 to 0.35. In most
cases, the exponent was statistically indistinguishable from
⅓. Just as BW2/3 is an index of BSA, BW1/3 is an index of
body length, a linear dimension. These findings are in ac-
cordance with the results of other studies of allometric scal-
ing of M-mode measurements and the predicted behavior
of geometrically similar objects.19,20,24–29 This study shows
that fitting the allometric equation to M-mode measure-
ments results in simple equations that can be used to predict
normal values in adult dogs that vary widely in size.
Fig 5. Cumulative percentage for fractional shortening (FS).
Cornell et al
50 25 5 2.5
Percentile Percentile Percentile Percentile r2 a
33 30 25 23 20.058ns
1.0 0.9 0.8 0.7 20.071ns
4.4 3.9 3.1 2.9 0.23*
This study also provides 95% prediction intervals for M-
mode measures for dogs ranging in size from 2 to 95 kg.
Many investigators who have examined the relationship be-
tween body size and M-mode measures have reported their
results with the 95% confidence interval for the regression
line. We have chosen to set the limits of normal for M-
mode measurements in the dog at the 95% prediction in-
terval for an individual observation. It is important to un-
derstand when the 95% confidence interval should be used
and when the 95% prediction interval should be used. The
95% confidence interval allows the user to say that there is
a 95% probability that the mean value of an M-mode var-
iable for all dogs of a particular weight will lie within the
bounds of the confidence interval. In clinical cardiology, a
clinician is rarely interested in knowing whether the mean
value for a group of dogs is normal. Instead the most com-
mon question to be answered is whether a value from an
individual dog is normal. If an M-mode measurement from
an individual dog is normal, there is a 95% probability that
it will fall within the bounds of the 95% prediction interval.
Most of the reference ranges for M-mode measurements
in dogs have been determined by 2 techniques.1,2,8,10,12 First,
several investigators have devised reference ranges with the
assumption that a linear relationship exists between left
ventricular diameters and wall thicknesses and BW or
BSA.1,2,8,10 Second, in order to avoid the problem of body
size, other investigators have developed reference values
that are based on a sample of mature dogs from a single
breed.12 We suspect that small sample size, small ranges of
body size, and the historical precedent of other studies to
use BSA or BW to index M-mode variables have led other
investigators to use a less than perfect model. We think that
many of the problems associated with reference values
Fig 6. Cumulative percentage of left atrial to aortic diameter (LA :
Ao).
 M-Mode Values in Dogs
Fig 7. Cumulative percentage for the ratio of left ventricular end
diastolic diameter to left ventricular free wall thickness in diastole
(LVIDd : LVWd).
based on body size have been eliminated in this study by
increasing the sample size, by increasing the range of body
sizes, and by transforming the data into a form that is ac-
curately described by a linear model. On the basis of these
data, a plot of M-mode measurements against BW or BSA
is distinctly curved with increasing scatter of the data as
weight increases. Scatter plots of data published from ear-
lier studies in dogs have a similar shape.5,11,15,27,29,32 The cur-
vature would be expected if canine hearts behave as geo-
metrically similar objects. When the same data were trans-
formed by plotting the logarithm of an M-mode measure-
ment against the logarithm of BW, the resulting plot formed
a straight line with reasonably uniform scatter. The equation
that describes a straight line fitted to these data is the log-
arithmic form of the allometric equation.
It is possible to take a series of geometrically similar
objects, such as cubes that are made of the same material
that only vary in size, and calculate their volumes by di-
viding the mass of each cube by the density of the material
the cubes are made from. The length of the edge of each
cube would be calculated by taking the cube root of its
volume. The surface area of the face of each cube is cal-
culated by squaring the length of the edge of the cube,
which is equivalent to raising the volume to the ⅔ power.
For any group of geometrically similar objects, the ratio of
volume to mass is constant, the ratio of linear measure-
ments to the cube root of mass is constant, and the ratio of
area to mass to the ⅔ power is constant. Equations that use
variations of the cube formula to calculate left ventricular
volume (LVVd) and mass (LVMASS) from M-mode mea-
sures [LVVd 5 (LVIDd)3, LVMASS 5 1.05(IVSTd 1
LVWd 1 LVIDd)3 2 (LVIDd)3], demonstrate these relation-
ships.53,54 Brown et al15 have shown that aortic diameter in
dogs can be predicted by the formula Ao 5 0.795BW1/3
and that ratios of linear M-mode dimensions in dogs are
constant.
Instead of using an equation to predict an absolute M-
mode value for an individual dog, a similar technique of
indexing can be used if a constant ratio exists between an
M-mode measurement and some measure of body size. The
method that has been used most often to attempt to nor-
malize M-mode measurements in dogs has been to calculate
the ratio between the M-mode measurement and BSA.12
The results from this study support the conclusion of others
317
who have shown that dividing linear M-mode measure-
ments by BSA will not normalize these measurements be-
cause their ratio is not constant.12,15,24
When the effects of body size were taken into account,
these data showed no striking breed differences in the M-
mode variables examined, except for a lower than expected
shortening fraction for Greyhound dogs. Although breed-
specific reference values for M-mode measurements still
might be useful, at this time, reference values only exist for
a few of the many breeds of dogs that are known. Even if
breed is a significant variable in predicting normal M-mode
variables, there will still always be a need for a method of
predicting heart size based on body size alone for compar-
ison. In other words, it is also impossible to determine
whether echocardiographic measurements from a particular
breed of dog differ from an ‘‘average’’ dog without a point
of reference. Also, basing reference values on body size is
the only technique appropriate for use in mixed breed dogs.
In addition, reference ranges based on body size also might
prove to be preferable to breed-specific reference ranges for
animals whose body size is unusually large or small com-
pared with the reference group.
Unlike absolute measures of heart size, fractional short-
ening, the ratio of left atrial diameter to the diameter of the
aortic root, and the ratio of left ventricular free wall thick-
ness to left ventricular chamber diameter generally have
been assumed to be free of the influence of body size. Be-
cause they are the ratios of 2 linear dimensions, these var-
iables would be expected to remain constant in animals that
are geometrically similar but differ in body size.15 This pre-
diction held true in the case of FS and LA : Ao, in which
no significant correlation was demonstrated between these
ratios and BW. The ratio LVWd : LVIDd showed a weak but
significant correlation with BW.
Fractional shortening is widely used as an indicator of
global left ventricular systolic function, and values ,25%
generally are thought to be associated with heart disease or
hypovolemia.55 A gray zone appears to exist around the
25% value, in which normal dogs and dogs with dilated
cardiomyopathy both can be found.56 Nevertheless, the 25%
value still could provide a useful dividing line because 95%
of the apparently normal dogs in this study had FS . 25%.
One obvious breed difference in fractional shortening was
identified: almost half of the dogs with FS , 25% were
Greyhounds, and almost half of the Greyhounds had FS ,
25%.
The coefficient of determination (r 2) indicates that for
measurements such as LVIDd and Ao, nearly 90% of the
variation in the data can be explained by BW alone. How-
ever, most of the M-mode variables examined in this study
had quite wide prediction intervals that can be approxi-
mated by adding or subtracting 20% from the mean. An
obvious source of variability in this study is the diverse
source of data, which were collected by many different ob-
servers who used different equipment in different environ-
ments. A previous study of the variability and reproduc-
ibility of echocardiographic measurements in the dog
showed that for M-mode measurements, the mean coeffi-
cient of variation for all pooled data was 15.7%.57 Another
study found that for M-mode measurements of left ventric-
ular dimensions, intraobserver variability ranged between
318 Cornell et al
2.3 and 6.2% and interobserver variability ranged between
1.3 and 12.9%.48 If data in this study had been collected in
a prescribed manner for the purpose of establishing refer-
ence values, we presumed that the prediction intervals
would have been narrower. Despite the limitations of this
study, the results appear to be comparable to those obtained
in people. The mean values and prediction intervals for
LVIDd in dogs from this study and boys of the same weight
are similar.28
It has not been determined how well these equations will
predict M-mode dimensions in animals that differ substan-
tially from the sample group. Predicted normal values for
animals that are very young or very old, animals that ex-
ercise intensely, and animals that are extremely obese or
very thin should be used cautiously. The use of these pre-
dictions could mask or mimic heart disease in some of these
dogs.
The effect of the sex of a dog on M-mode measurements
has been examined in Beagles, West Highland White Ter-
riers, and Greyhounds.39,40,47,48,58 Hanton et al40 found
LVIDd, IVSTd, and LVWd to be significantly greater in
males than in females but did not take the greater weight
of male dogs into account. Crippa et al39 only found LVWd
to be significantly greater in males. Lonsdale et al,58 on the
other hand, found a number of variables to be greater in
female dogs. Badde et al48 found no significant difference
between males and females for left ventricular dimensions.
On the basis of the limited amount of data available, the
effect of sex appears to be small and unpredictable.
Fat-free mass (FFM) has been shown to be a better pre-
dictor of M-mode measurements and M-mode–derived left
ventricular mass than BW in humans.59 M-mode measure-
ments might be expected to be the same in dogs of equal
FFM but different BWs. Lister et al60 found no significant
difference in left ventricular chamber dimensions and wall
thickness in normal cats weighing 4.1 kg and obese cats
weighing 7.7 kg. Dogs fed a high-fat diet that increased
their BW from a mean of 12.9 to 15.7 kg showed no sig-
nificant change in left ventricular wall thickness and only
a small but significant increase in left ventricular diameters
(LVIDd 3.3–3.5; LVIDs 2.0–2.2).61
Previous studies have demonstrated the effect of changes
in heart rate on M-mode measurements.3,62–65 The results of
this study are consistent with other studies with dogs. A
20-kg dog with a heart rate of 60 beats/min would have a
predicted LVIDd of 3.9 cm. The same dog with a heart rate
of 150 beats/min would have a predicted LVIDd of 3.6 cm.
In 2 studies, training (running and pulling a sled or cart)
was shown to increase several M-mode measurements in
dogs, including left ventricular wall thickness and chamber
dimensions.38,58 It is possible that some dogs, randomly dis-
tributed throughout the sample group, received enough ex-
ercise to exhibit a training effect.
Age can cause changes in the echocardiogram. Because
very young animals were not included in this sample group,
the results of this study might not apply to them. Data from
previous studies that examined groups of growing puppies
of 3 breeds (Spanish Mastiffs, English Pointers, and Por-
tuguese Water Dogs) showed that normalized left ventric-
ular diameter and wall thickness are smaller in very young
puppies than in adult dogs.27,29,66 This effect does not appear
to be caused by the puppies’ smaller body size because
mature dogs of BW similar to the puppies studied have
greater normalized dimensions that are comparable to other
adult dogs. LVIDd measured 1.7 cm and LVIDs measured
0.9 cm in a group of 4-week-old Spanish Mastiff puppies
with a mean weight of 3.4 kg. In a group of mature Min-
iature Poodles with a median weight of 3 kg, median values
for LVIDd and LVIDs were 2.0 and 1.0 cm, respectively.
Normalized LVIDd was 1.19 cm/kg0.294 in the Spanish Mas-
tiff puppies and 1.45 cm/kg0.294 in the mature Miniature
Poodles.
Sixty of the 494 dogs included in this study were sedated
with acepromazine and morphine. The use of anesthetic or
sedative drugs is known to affect echocardiographic mea-
surements.67–77 Twenty of the sedated dogs were Grey-
hounds, a breed in which the effects of a similar sedative
combination have been studied. Page et al46 examined 16
Greyhounds sedated with acepromazine (0.05 mg/kg IV)
and meperidine (1 mg/kg IV) and then later examined the
same dogs without sedation. The authors considered the
results in sedated and unsedated dogs to be similar.
The effect of breed on the echocardiogram is controver-
sial. Athletic ability and susceptibility to heart disease are
undoubtedly influenced by dog breed, and it would be sur-
prising if breed of dog did not also affect the size and
function of the heart.38,47,78 Greyhounds and Alaskan Sled
Dogs are bred for their athletic ability and appear to have
larger, heavier hearts and, in some instances, unusually low
values for fractional shortening.38,47 In breeds susceptible to
dilated cardiomyopathy, such as the Doberman Pinscher
and Irish Wolfhound, a great deal of effort has been directed
toward determining whether certain changes in heart size
and fractional shortening found in these dogs are the result
of normal variation or occult heart disease. Unless an iden-
tifiable cause of the disease in these breeds is found, these
questions will be impossible to answer.
One study objective was to determine prediction intervals
for various M-mode variables for normal dogs of varying
weights on the basis of the data collected. This study used
data collected retrospectively by a relatively large number of
investigators. Consequently, there was no means of stan-
dardizing the method of data collection. Because of the large
number of dogs studied, it is unlikely that the conclusion
regarding the superiority of BW1/3 over other indexes based
on BW is in error. However, the prediction intervals might
not reflect the accuracy that could be obtained by, for ex-
ample, a single, experienced echocardiographer doing a
study on a similar number of dogs prospectively. Although
the techniques for measuring cardiac dimensions are stan-
dardized in humans and these standards are used for dogs,
this is no guarantee that all measurements used in this study
are as accurate as possible.79 For example, in a dog, one way
to make a left ventricular measurement more accurate is to
guide the examination by two 2-dimensional echocardio-
graphic images (eg, by aligning the M-mode cursor perpen-
dicular to the walls of the left ventricle in a right parasternal
long-axis view and then making certain the cursor is in the
center of and at the correct level within the chamber in a
right parasternal short-axis view). Breathing artifact is com-
mon in dogs, so another method of obtaining a more accurate
measurement is to stop the dog from breathing by closing
 M-Mode Values in Dogs
the mouth and occluding the nostrils for several seconds. If
all of these techniques had been applied prospectively in this
study, it is likely that the prediction intervals would have
been smaller (eg, from the clinical experience of some of the
authors, when measurements have been made with utmost
care, 95% of normal dogs appear to be closer to 610% of
the mean rather than the 620% found in this study). How-
ever, because these techniques are often not employed by
individuals performing echocardiography, the prediction in-
tervals presented in this study probably do represent the ac-
tual prediction intervals for normal dogs for the majority of
individuals performing echocardiography. This conclusion is
borne out by the close match of these prediction intervals to
those found in several other studies in dogs and in specific
dog breeds.40,45. However, it would be best if a prospective
study of a large number of dogs of all sizes with the use of
accurate techniques was designed and carried out in the future.
No attempt was made to examine dogs with cardiac dis-
ease to determine the amount of overlap between the pre-
diction intervals calculated in this study and prediction in-
tervals for cardiac dimensions seen with various cardiac
diseases. Consequently, we make no claim that the predic-
tion intervals presented here can be used to discriminate
normal dogs from dogs with cardiac disease, especially
those with mild disease. However, presenting the prediction
intervals is useful because they can be used in other con-
texts, such as for comparing specific dog breeds to the nor-
mal population examined in this study.
Because body weight, breed, and body type are closely
linked, no attempt was made to determine the effect of
breed or body type on the measured variables. Not all
breeds were included in this study. Consequently, the data
might not be applicable to all dog breeds.
Logarithmic transformation of M-mode measurements
and body weight results in data that meet the requirements
for linear regression. The equation resulting from the re-
gression analysis is the logarithmic form of the allometric
equation. The exponent in the allometric equation varies
according to whether volume, area, or length is to be pre-
dicted from weight in geometrically similar objects. Dogs
appear to behave as if they are geometrically similar to one
another, and M-mode measurements have a direct linear
relationship to BW raised to the 0.22–0.35 power, which is
statistically indistinguishable from ⅓ in most cases. The
prediction intervals from the regression analyses and the
ability to normalize M-mode values make it possible to
compare M-mode measurements in normal dogs of differ-
ent sizes. The equations developed from this study appear
to be applicable to normal adult dogs of most breeds.
Footnotes
a
Lotus 1-2-3 Release 9 for Windows, Lotus Development Corporation,
Plover, WI
b
StatView for Windows Version 5.0.1, SAS Institute Inc., Cary, NC
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