A Novel Method of Expressing Left Ventricular Mass Relative to Body Size in Children

Abstract

Background-Left ventricular (LV) hypertrophy (LVH) in children is widely defined as a left ventricular mass index (LVMI, g/m 2.7 ) Ͼ95th percentile. However, LVMI increases with decreasing height in young children; thus, the 95th percentile LVMI will depend on the height distribution of the reference population. The objective of this study was to compare the performance of a novel method of expressing LV mass relative to body size (centile curves) with the LVMI method. Methods and Results-LV mass was estimated by M-mode echocardiography in 440 healthy nonobese reference children (birth to 21 years) and 239 children at risk for LVH; the LVMI was calculated for all children. Three samples of 270 children, each with different height distributions, were drawn from the reference population. A sample-specific 95th percentile LVMI was determined for each reference sample. At-risk children were classified as having LVH or not based on each sample-specific 95th percentile. Four LV mass-for-height centile curves were constructed with the Cole lambda-mu-sigma method and data from each reference sample. At-risk children were each assigned an LV mass-for-height percentile with these curves and were reclassified as having LVH if LV mass-for-height was Ͼ95th percentile. The centile method provided a stable estimate of the proportion of at-risk children with LVH regardless of reference group, whereas proportion estimates varied significantly depending on the reference population when the LVMI method was used.

Defining Left Ventricular Hypertrophy in Children on Peritoneal Dialysis

“…In analogy to the findings of Foster et al and Khoury et al in healthy children (14,15), we observed a significant inverse relationship of this LVMI with body size in children shorter than 130 cm. Although we cannot rule out the possibility of more marked LVH in young as compared with older children on dialysis, it is most likely that the Effect of reference to height age rather than chronological age on LVMI percentile assignment.…”

“…Recently, Foster et al studied 440 healthy children and 239 children at risk of LVH (14). This single-center study was carefully standardized and a single cardiologist performed all measurements.…”

“…The following definitions of LVH were compared: (1) LVMI exceeding 38.6 g/m 2.7 (13), (2) LVMI exceeding the 95th percentile for gender and chronological age according to Khoury et al (15), (3) substituting chronological age by height age (i.e., the age of a child of the same height growing at the 50th height percentile), and (4) LVM exceeding the 95th percentile (i.e., LVM SDS Ͼ 1.645) according to the lambda-mu-sigma (LMS) reference charts provided by Foster et al (14). Associations were assessed by Spearman correlation analysis and linear regression analysis.…”

“…Until recently, LVH in children used to be defined by the fixed LVMI partition value of 38.6 g/m 2.7 , which defines the 95th percentile of LVMI distribution in healthy children and adolescents from 6 to 17 years of age (13). The age-independency of the LVMI has recently been questioned for infants and young children (14,15), and the use of height-specific percentile charts or SD scores (SDS) for LVMI has been advocated to establish the diagnosis of LVH in children (14,15).…”

Cardiomyocyte proliferation contributes to heart growth in young humans

“…The LV reference mass of each heart for which heart weight was not available as the mean normal value for body surface area was calculated according to normal z-score values described in ref. 41. Our calculations were based on data from 576 healthy humans obtained at Boston Children's Hospital within an institutional review boardapproved study.…”