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Age-specific reference intervals for indexed left ventricular mass in children
Philip R Khoury1, Mark Mitsnefes, Stephen R Daniels
1Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
Insights
Left ventricular mass indexed to height(2.7) shows little variation in children over 9 years old. However, values in younger children vary significantly, requiring age-specific percentile curves for accurate assessment of cardiac health.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Biomedical Engineering
Background:
- Left ventricular mass (LVM) indexing is crucial for assessing cardiac health in children.
- The standard LVM indexing method (LVM/height^2.7) is well-established for older children.
- Understanding LVM/height^2.7 variations in younger children is essential for accurate diagnosis.
Purpose of the Study:
- To establish normal values for LVM/height^2.7 in the pediatric age group.
- To determine the variability of LVM/height^2.7 across different pediatric age ranges.
- To provide reference data for pediatric cardiology assessments.
Main Methods:
- M-mode echocardiography was performed on 2,273 healthy, nonobese children (aged 0-18 years).
- Left ventricular mass was calculated and indexed to height raised to the power of 2.7 (LVM/height^2.7).
- Quantile curves (5th-95th percentile) were constructed for LVM/height^2.7 based on age and sex.
Main Results:
- In children over 9 years old, median LVM/height^2.7 remained relatively stable (27-32 g/m^2.7).
- In children under 9 years old, LVM/height^2.7 showed significant age-related variation.
- Newborns and infants exhibited LVM/height^2.7 values approximately double those of older children, with the 95th percentile decreasing from 80 g/m^2.7 at birth to 40 g/m^2.7 at age 11.
Conclusions:
- For children > 9 years, abnormal LVM/height^2.7 is >40 g/m^2.7 (girls) or >45 g/m^2.7 (boys).
- For children < 9 years, LVM/height^2.7 must be compared to age-specific percentile curves due to significant variation.
- The findings highlight the need for improved LVM indexing methods in younger children while providing valuable reference data.
Background:
In older children, one of the standards for indexing left ventricular mass (LVM) is height raised to an exponential power of 2.7. The purpose of this study was to establish a normal value for the pediatric age group and to determine how, if at all, LVM/height(2.7) varies in children.
Methods:
M-mode echocardiography was performed in 2,273 nonobese, healthy children (1,267 boys, 1,006 girls; age range 0-18 years). Curves were constructed for the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantiles of LVM/height(2.7).
Results:
In children aged > 9 years, median LVM/height(2.7) ranged from 27 to 32 g/m(2.7) and had little variation with age. However, in those aged < 9 years, LVM/height(2.7) varied significantly, and percentiles for newborns and infants were approximately double the levels for older children and adolescents: the 95th percentile ranged from 80 g/m(2.7) for newborns to 40 g/m(2.7) for 11-year-olds.
Conclusion:
For patients aged > 9 years, quantiles of LVM/height(2.7) vary little, and values > 40 g/m(2.7) in girls and > 45 g/m(2.7) in boys can be considered abnormal (ie, > 95th percentile). However, for patients aged < 9 years, the index varies with age, and therefore, measured LVM/height(2.7) must be compared with percentile curves, which are provided. This variation in LVM/height(2.7) in younger children indicates that a better indexing method is needed for this age group. Nevertheless, these data are valuable in that they provide normal values with which patient data can be compared.
