Reference Values and Calculation of z-Scores of Echocardiographic Measurements of the Normal Pediatric Right Ventricle

Koestenberger, Martin; Nagel, Bert; Ravekes, William; Avian, Alexander; Burmas, Ante; Grangl, Gernot; Cvirn, Gerhard; Gamillscheg, Andreas

doi:10.1016/j.amjcard.2014.08.028

Cited by 41 publications

(38 citation statements)

References 21 publications

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“…Infants were allowed to be bottle fed during the examination. In our children of the healthy cohort, we confirmed a normal left ventricular ejection fraction, measured using the Simpson formula, a normal age-related mitral annular plane systolic excursion, 16 as well as a normal RV size 17 and RV systolic function 18,19 by including only patients with normal age-related RV size parameters, and normative tricuspid annular plane systolic excursion (TAPSE) and RV tricuspid annular peak systolic velocity values.…”

Section: Healthy Study Groupmentioning

confidence: 67%

“…In our healthy pediatric study population, we confirmed a normal RV size and systolic function by including only patients with normal age-related RV size, RVOT size, TAPSE, and RV S′. [17][18][19][35][36][37] Proper placement of the Doppler cursor in the middle of the pulmonary artery from the parasternal short-axis view and accurate alignment of the long axis of the main PA are both important steps in the use of PAAT measurement. The number of our pediatric PH patients was small, and the possible influence of differences in treatment, including surgery in the PAH-CHD patient population, cannot be excluded.…”

Section: Discussionmentioning

confidence: 88%

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Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension

Koestenberger

Grangl

Avian

et al. 2017

Circ: Cardiovascular Imaging

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Background-Pulsed-wave Doppler determination of the pulmonary artery acceleration time (PAAT) as a surrogate for pulmonary artery pressure was found to be of clinical value for assessment of pulmonary hypertension (PH) with studies to date exclusively performed in adults. This study aims to provide representative, normal reference values for PAAT in children of all ages. Moreover, we validated abnormal PAAT values in 54 children with PH. Methods and Results-We conducted a prospective echocardiographic study in 756 healthy children (aged 1 day to 18 years) and in 54 children with PH. Possible associations of age, body length, body weight, body surface area, and heart rate on PAAT were investigated. The PAAT correlated positively with age (r=0.848), body length (r=0.871), body surface area (r=0.856), and body weight (r=0.825) and negatively with heart rate (r=−0.906). PAAT increased with age (neonates: median: 81 ms, range: 53-104; 18th year of life: median: 151 ms, range: 107-187). Receiver operating characteristic analysis for detecting PH patients using age-specific z scores showed an excellent performance of PAAT (P<0.001; area under the curve, 0.98; 95% confidence interval, 0.97-0.99) with a best cutoff score according to Youden index of -1.565 (sensitivity: 92%, specificity: 96%). PAAT values of PH patients negatively correlated (ρ=−0.497) with pulmonary vascular resistance. Conclusions-The PAAT normal reference values and z scores we provide here will be useful to identify children with a shortened PAAT. Abnormal PAAT values with scores <−2 were predictive of PH. (Circ Cardiovasc Imaging.

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Section: Healthy Study Groupmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 88%

Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension

Koestenberger

Grangl

Avian

et al. 2017

Circ: Cardiovascular Imaging

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“…The ASE has published recommendations for quantification methods during the performance of a pediatric echocardiogram, with the RV internal-dimension parameters described as useful but with normative data for a comparison to dilated RVs still not available. 23 Recently, normative data of the pediatric RV internal dimensions have been published, 108,109 with sufficient TTE data of enlarged RV dimensions in pediatric PH currently missing. RV and RA enlargement, plus interatrial septal bowing from right to left (as shown in Fig.…”

Section: Rv and Ra Enlargementmentioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

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Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.

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“…There have been multiple studies for calculating Z-scores of various cardiac structures. [15] The most recent publications in this area[51617181920] reveal that none of the latest Z-score research has come from any developing country.…”

Section: Discussionmentioning

confidence: 99%

“…Almost all these studies[51617181920] have been done on hospital-based samples. Hospital-based samples have their inherent disadvantages including selection bias.…”

Section: Discussionmentioning

confidence: 99%

A pediatric echocardiographic Z-score nomogram for a developing country

Anantharaj

Gokhroo

Bisht

et al. 2017

Annals of Pediatric Cardiology

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Background:Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries.Objective:This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each.Subjects and Methods:The study was conducted at two centers in India - Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system.Results and Analysis:For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived.Conclusions:The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.

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Reference Values and Calculation of z-Scores of Echocardiographic Measurements of the Normal Pediatric Right Ventricle

Cited by 41 publications

References 21 publications

Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension

Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

A pediatric echocardiographic Z-score nomogram for a developing country

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