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

https://doi.org/10.1016/j.amjcard.2014.08.028Get rights and content

Highlights

  • Normal pediatric RV dimensions were measured and z scores calculated in 576 healthy children and 37 children with hemodynamically relevant ASDs.

  • This is the first study presenting normal ranges of RV systolic and diastolic dimensions in children from infancy to 18 years of age.

  • RV z scores > 2 SDs were predictive for detecting ASD in patients <8 years of age with enlarged right ventricles.

Determination of right ventricular (RV) size and function has gained more interest in recent years in adults and children, especially in patients with congenital heart disease. Data on normal RV size parameters in children are scant. The aim of this study was to investigate growth-related changes in RV internal dimensions in a healthy pediatric cohort and the predictive value of RV parameters in identifying enlarged right ventricles in children with secundum-type atrial septal defects (ASD). A prospective study was conducted in a group of 576 healthy children (aged 1 day to 18 years) and 37 children (aged 1.4 to 17.7 years) with moderate-sized to large ASDs. The effects of age, body length, body weight, and body surface area were determined on the following RV parameters: end-diastolic basal diameter, end-diastolic midcavity diameter, end-diastolic length, end-systolic length, end-diastolic area, and end-systolic area. The predictive value of normal values stratified for age, body weight, body length, and body surface area was tested in children with ASDs. RV end-diastolic basal diameter, end-diastolic midcavity diameter, end-diastolic length, end-systolic length, end-diastolic area, and end-systolic area showed positive correlations with age, body length, body surface area, and body weight. In this population, RV z scores showed high specificity for detecting patients with ASDs, with sensitivity up to 89%, especially in children <8 years of age. In conclusion, the normal ranges of pediatric RV internal dimensions are provided. The z scores of these RV parameters were also calculated. Normal RV z scores might be important predictors in identifying enlarged right ventricles in patients with ASDs.

Section snippets

Methods

The healthy study group consisted of 576 pediatric patients (328 male, 248 female). Only subjects whose echocardiographic results were judged normal by one of our staff pediatric cardiologists were included. The study group encompassed neonates to adolescents (aged 1 day to 18 years, BW 2.8 to 98.0 kg, BSA 0.20 to 2.23 m2), including 46 neonates and 64 infants. All patients with CHDs or acquired heart disease, chest and thoracic spine deformities, or chromosomal syndromes were excluded from

Results

All investigated RV variables, RVEDb-d, RVEDm-d, RVEDL, RVESL, RVEDa, and RVESa, increased from neonates to adolescents in a nonlinear way. The RVEDb-d RVEDm-d, RVEDL, RVESL, RVEDa, and RVESa data are shown in Figures 2 and 3, listed in Table 1, Table 2, Table 3, and shown in Supplementary Figures A and B.

Because of the strong collinearity of BSA and age, separate models for age and BSA were calculated. For RVEDb-d, RVEDm-d, RVEDL, RVESL, RVEDa, and RVESa, age, BL, BW, and BSA were significant

Discussion

Our study was undertaken to obtain normal RV internal dimensions values in a healthy pediatric study group. Our secondary aim was to see if those normal values could accurately predict RV dilatation in patients with moderate to large ASDs. It is important to create age-related normal values for children because pediatric cardiologists, unlike their adult colleagues, need to have measurements indexed to age, BL, BW, and BSA because of the variability of age-dependent growth. Quantitative

Disclosures

The authors have no conflicts of interest to disclose.

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