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Cantinotti M, Scalese M, Contini FV, Franchi E, Viacava C, Corana G, Pizzuto A, Pietro M, Santoro G, Assanta N. Comprehensive Two-Dimensional Pediatric Echocardiographic Nomograms for Coronary Artery Sizes in Caucasian Children and Comparison among Major Nomograms. Diagnostics (Basel) 2024; 14:1029. [PMID: 38786327 PMCID: PMC11119586 DOI: 10.3390/diagnostics14101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Although coronary artery nomograms in children have been published, data on Caucasian children are lacking. The aim of this study is to provide: (i) a full dataset of coronary artery diameters in healthy children and (ii) a comparison among major previous nomograms. MATERIALS AND METHODS We prospectively evaluated 606 healthy subjects (age range, 1 days-<18 years; median age 8.7 years; 62.5% male). Coronary artery measurements in a short-axis view were performed. Age, heart rate, and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. To assess the accuracy of the predictive models of different studies, a Z-score calculator was created using Lopez's nomograms for comparison. RESULTS The association with BSA was found to be stronger, and was used for normalization of our data. The best-fit models, satisfying the assumption of homoscedasticity and normality of residuals and showing the highest R2 scores, were logarithmic (ln[y] = a + b*ln[x]). Predicted values and Z-score boundaries by BSA are provided. Our ranges of normality are slightly lower than those, diverging from -0.22 to -0.59 Z-scores for the left main coronary artery and from -0.23 to -0.3 Z-scores for the right coronary artery. CONCLUSIONS We report a complete dataset of normal echocardiography coronary artery diameter (including new measures of the proximal origin) values in a large population of healthy children. Our data were statistically like those of north American nomograms.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Marco Scalese
- Department of Statistics, National Research Institute, National Research Council, 56121 Pisa, Italy;
| | | | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Cecilia Viacava
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Giulia Corana
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Alessandra Pizzuto
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Marchese Pietro
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
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Cantinotti M, Marchese P, Franchi E, Santoro G, Assanta N, Giordano R. Four-Dimensional Flow Echocardiography: Blood Speckle Tracking in Congenital Heart Disease: How to Apply, How to Interpret, What Is Feasible, and What Is Missing Still. Healthcare (Basel) 2024; 12:263. [PMID: 38275542 PMCID: PMC10815034 DOI: 10.3390/healthcare12020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Blood speckle tracking echocardiography (BSTE) is a new, promising 4D flow ultrafast non-focal plane imaging technique. The aim of the present investigation is to provide a review and update on potentialities and application of BSTE in children with congenital heart disease (CHD) and acquired heart disease. A literature search was performed within the National Library of Medicine using the keywords "echocardiography", "BST", and "children". The search was refined by adding the keywords "ultrafast imaging", "CHD", and "4D flow". Fifteen studies were finally included. Our analysis outlined how BSTE is highly feasible, fast, and easy for visualization of normal/abnormal flow patterns in healthy children and in those with CHD. BSTE allows for visualization and basic 2D measures of normal/abnormal vortices forming the ventricles and in the main vessel. Left ventricular vortex characteristics and aortic flow patterns have been described both in healthy children and in those with CHD. Complex analysis (e.g., energy loss, vorticity, and vector complexity) are also highly feasible with BSTE, but software is currently available only for research. Furthermore, current technology allows for BSTE only in neonates and low-weight children (e.g., <40 kg). In summary, the feasibility and potentialities of BSTE as a complementary diagnostic tool in children have been proved; however, its systemic use is hampered by the lack of (i) accessible tools for complex quantification and for acquisition at all ages/weight, (ii) data on the diagnostic/prognostic significance of BSTE, and (iii) consensus/recommendation papers indicating when and how BSTE should be employed.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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Cantinotti M, McMahon CJ, Marchese P, Köstenberger M, Scalese M, Franchi E, Santoro G, Assanta N, Jacquemyn X, Kutty S, Giordano R. Echocardiographic Parameters for Risk Prediction in Borderline Right Ventricle: Review with Special Emphasis on Pulmonary Atresia with Intact Ventricular Septum and Critical Pulmonary Stenosis. J Clin Med 2023; 12:4599. [PMID: 37510714 PMCID: PMC10380858 DOI: 10.3390/jcm12144599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of the present review is to highlight the strengths and limitations of echocardiographic parameters and scores employed to predict favorable outcome in complex congenital heart diseases (CHDs) with borderline right ventricle (RV), with a focus on pulmonary atresia with intact ventricular septum and critical pulmonary stenosis (PAIVS/CPS). A systematic search in the National Library of Medicine using Medical Subject Headings and free-text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords "PAIVS/CPS", Ebstein's anomaly, and unbalanced atrioventricular septal defect with left dominance. A total of 22 studies were selected for final analysis; 12 of them were focused on parameters to predict biventricular repair (BVR)/pulmonary blood flow augmentation in PAIVS/CPS. All of these studies presented numerical (the limited sample size) and methodological limitations (retrospective design, poor definition of inclusion/exclusion criteria, variability in the definition of outcomes, differences in adopted surgical and interventional strategies). There was heterogeneity in the echocardiographic parameters employed and cut-off values proposed, with difficultly in establishing which one should be recommended. Easy scores such as TV/MV (tricuspid/mitral valve) and RV/LV (right/left ventricle) ratios were proven to have a good prognostic accuracy; however, the data were very limited (only two studies with <40 subjects). In larger studies, RV end-diastolic area and a higher degree of tricuspid regurgitation were also proven as accurate predictors of successful BVR. These measures, however, may be either operator and/or load/pressure dependent. TV Z-scores have been proposed by several authors, but old and heterogenous nomograms sources have been employed, thus producing discordant results. In summary, we provide a review of the currently available echocardiographic parameters for risk prediction in CHDs with a diminutive RV that may serve as a guide for use in clinical practice.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
- Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Colin Joseph McMahon
- Department of Pediatric Cardiology, Childrens Health Ireland, D12 N512 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Martin Köstenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University Graz, 8036 Graz, Austria
| | - Marco Scalese
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | | | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Xander Jacquemyn
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
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Vøgg ROB, Sillesen AS, Wohlfahrt J, Pihl C, Raja AA, Vejlstrup N, Norsk JB, Elia E, Sleeper LA, Colan SD, Iversen KK, Boyd HA, Bundgaard H. Normative Echocardiographic Left Ventricular Parameters and Reference Intervals in Infants. J Am Coll Cardiol 2023; 81:2175-2185. [PMID: 37257953 DOI: 10.1016/j.jacc.2023.03.423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND In pediatric echocardiography, reference intervals are required to distinguish normal variation from pathology. Left ventricular (LV) parameters are particularly important predictors of clinical outcome. However, data from healthy newborns are limited, and current reference intervals provide an inadequate approximation of normal reference ranges. OBJECTIVES Normative reference intervals and z-scores for 2-dimensional echocardiographic measurements of LV structure and function based on a large group of healthy newborns were developed. METHODS The study population included 13,454 healthy newborns from the Copenhagen Baby Heart Study who were born at term to healthy mothers, had an echocardiogram performed within 30 days of birth, and did not have congenital heart disease. To develop normative reference intervals, this study modeled 10 LV parameters as a function of body surface area through joint modeling of 4 statistical components. RESULTS Infants in the study population (48.5% were female) had a median body surface area of 0.23 m2 (IQR: 0.22-0.25 m2) and median age of 12.0 days (IQR: 8.0-15.0 days) at examination. All normative reference intervals performed well in both sexes without stratification on infant sex. In contrast, creation of separate reference models for infants examined at <7 days of age and those examined at 7-30 days of age was necessary to optimize the performance of the reference intervals. CONCLUSIONS This study provides normative reference intervals and z-scores for 10 clinical, widely used echocardiographic measures of LV structure and function based on a large cohort of newborns. These results provide highly needed reference material for clinical application by pediatric cardiologists.
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Affiliation(s)
- R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Pihl
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jakob B Norsk
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Eleni Elia
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kasper K Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heather A Boyd
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Reference Standards in Quantitative Pediatric Echocardiography: A Guide to the Nuanced World of Z Scores and Nomograms. J Am Soc Echocardiogr 2023; 36:324-326. [PMID: 36549924 DOI: 10.1016/j.echo.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
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Schweintzger S, Kurath-Koller S, Burmas A, Grangl G, Fandl A, Noessler N, Avian A, Gamillscheg A, Chouvarine P, Hansmann G, Koestenberger M. Normal Echocardiographic Reference Values of the Right Ventricular to Left Ventricular Endsystolic Diameter Ratio and the Left Ventricular Endsystolic Eccentricity Index in Healthy Children and in Children With Pulmonary Hypertension. Front Cardiovasc Med 2022; 9:950765. [PMID: 35911557 PMCID: PMC9332913 DOI: 10.3389/fcvm.2022.950765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAn accurate assessment of the right and left ventricle and their interaction is important in pediatric pulmonary hypertension (PH). Our objective was to provide normal reference values for the right ventricular to left ventricular endsystolic (RV/LVes) ratio and the LV endsystolic eccentricity index (LVes EI) in healthy children and in children with PH.MethodsWe conducted an echocardiographic study in 769 healthy children (median age: 3.36 years; range: 1 day—18 years) and validated abnormal values in 44 children with PH (median age: 2.1 years; range: 0.1 months—17.7 years). We determined the effects of gender, age, body length, body weight, and body surface area (BSA) on RV/LVes ratio and LVes EI values. The RV/LVes ratio and LVes EI were measured from the parasternal short axis view between papillary muscle from the endocardial to endocardial surfaces.ResultsBoth, the RV/LVes ratio and the LVes EI were highly age-dependent: (i) neonates RV/LVes ratio [median 0.83 (range 0.53–1.37)], LVes EI [1.21 (0.92–1.45)]; (ii) 12–24 months old: RV/LVes ratio: [0.55 (0.35–0.80)], LVes EI: [1.0 (0.88–1.13)]; iii) 18th year of life RV/LVes ratio: [0.53 (0.32–0.74)], LVes EI: [1.0 (0.97–1.07)]. Healthy neonates had high LVes EI and RV/LVes ratios, both gradually decreased within the first year of life and until BSA values of about 0.5 m2, body weight to about 15 kg and body length to about 75 cm, but were almost constant thereafter. Children (>1 year) and adolescents with PH had significantly higher RV/LVes ratio (no PH: median 0.55, IQR 0.49–0.60; PH: 1.02, 0.87–1.26; p < 0.001) and higher LVes EI values (no PH: 1.00, 0.98–1.00; PH: 1.53, 1.26–1.71; p < 0.001) compared to those without PH. To predict the presence of PH in children > 1 year, we found the following best cutoff values: RV/LVes ratio ≥ 0.67 (sensitivity: 1.00, specificity: 0.95) and LVes EI ≥ 1.06 (sensitivity: 1.00, specificity: 0.97).ConclusionWe provide normal echocardiographic reference values of the RV/LVes ratio and LVes EI in healthy children, as well as statistically determined cutoffs for the increased values in children with PH.
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Affiliation(s)
- Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
- *Correspondence: Sabrina Schweintzger,
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Andrea Fandl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Nathalie Noessler
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andreas Gamillscheg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Philippe Chouvarine
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hanover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hanover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
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Lopez L, Frommelt PC, Colan SD, Trachtenberg FL, Gongwer R, Stylianou M, Bhat A, Burns KM, Cohen MS, Dragulescu A, Freud LR, Frommelt MA, Lytrivi ID, Mahgerefteh J, McCrindle BW, Pignatelli R, Prakash A, Sachdeva R, Soslow JH, Spurney C, Taylor CL, Thankavel PP, Thorsson T, Tretter JT, Young LT, LuAnn Minich L. Pediatric Heart Network Echocardiographic Z Scores: Comparison with Other Published Models. J Am Soc Echocardiogr 2021; 34:185-192. [PMID: 33189460 PMCID: PMC7870534 DOI: 10.1016/j.echo.2020.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Different methods have resulted in variable Z scores for echocardiographic measurements. Using the measurements from 3,215 healthy North American children in the Pediatric Heart Network (PHN) echocardiographic Z score database, the authors compared the PHN model with previously published Z score models. METHODS Z scores were derived for cardiovascular measurements using four models (PHN, Boston, Italy, and Detroit). Model comparisons were performed by evaluating (1) overlaid graphs of measurement versus body surface area with curves at Z = -2, 0, and +2; (2) scatterplots of PHN versus other Z scores with correlation coefficients; (3) Bland-Altman plots of PHN versus other Z scores; and (4) comparison of median Z scores for each model. RESULTS For most measurements, PHN Z score curves were similar to Boston and Italian curves but diverged from Detroit curves at high body surface areas. Correlation coefficients were high when comparing the PHN model with the others, highest with Boston (mean, 0.99) and lowest with Detroit (mean, 0.90). Scatterplots suggested systematic differences despite high correlations. Bland-Altman plots also revealed poor agreement at both extremes of size and a systematic bias for most when comparing PHN against Italian and Detroit Z scores. There were statistically significant differences when comparing median Z scores between the PHN and other models. CONCLUSIONS Z scores from the multicenter PHN model correlated well with previous single-center models, especially the Boston model, which also had a large sample size and similar methodology. The Detroit Z scores diverged from the PHN Z scores at high body surface area, possibly because there were more subjects in this category in the PHN database. Despite excellent correlation, significant differences in Z scores between the PHN model and others were seen for many measurements. This is important when comparing publications using different models and for clinical care, particularly when Z score thresholds are used to guide diagnosis and management.
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Affiliation(s)
- Leo Lopez
- Stanford University School of Medicine, Palo Alto, California.
| | | | | | | | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Aarti Bhat
- Seattle Children's Hospital, Seattle, Washington
| | - Kristin M Burns
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | - Carolyn L Taylor
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | - Luciana T Young
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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