Related Experiment Video
Updated: Mar 30, 2026
Echocardiographic Approaches and Protocols for Comprehensive Phenotypic Characterization of Valvular Heart Disease in Mice
Published on: February 14, 2017
Nomograms for mitral inflow Doppler and tissue Doppler velocities in Caucasian children
Massimiliano Cantinotti1, Raffaele Giordano1, Marco Scalese2
1Tuscany Foundation "G. Monasterio", Massa and Pisa, Italy.
Insights
Establishing pediatric nomograms for mitral valve (MV) pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) velocities is crucial. This study presents normal ranges from a large cohort, highlighting variability in diastolic patterns in younger children.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Existing pediatric echocardiographic nomograms for systolic/diastolic function indices suffer from small sample sizes and inconsistent methodologies.
- Accurate reference data for mitral valve (MV) pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) velocities in children are limited.
Purpose of the Study:
- To establish pediatric nomograms for mitral valve (MV) pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) velocities.
- To provide reliable normative data for diastolic function assessment in children.
Main Methods:
- Prospective study of 904 healthy Caucasian Italian children aged 0 days to 17 years.
- PWD and TDI measurements of MV velocities were performed.
- Statistical models were generated to assess relationships between velocities and independent variables (age, weight, height, HR, BSA), accounting for heteroscedasticity.
Main Results:
- Higher coefficients of determination (R(2)) were observed for PWD-E deceleration time (0.53) and septal (Se')/lateral (Le') MV-TDI e' velocity (Se': 0.54; Le': 0.55).
- Variability in measurements was greater in younger children and those with lower body surface area (BSA).
- Low R(2) values precluded the generation of z-scores and estimated percentiles, necessitating presentation of observed percentiles by age.
Conclusions:
- Normal ranges for PWD and TDI mitral velocities were established from a large pediatric population.
- Significant variability in diastolic patterns, particularly in younger children, must be considered when interpreting echocardiographic data.
Background:
Pediatric echocardiographic nomograms for systolic/diastolic functional indices are limited by small sample size and inconsistent methodologies. Our aim was to establish pediatric nomograms for mitral valve (MV) pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) velocities.
Methods:
We performed PWD/TDI measurements of MV velocities and generated models testing for linear/logarithmic/exponential/square root relationships. Heteroscedasticity was accounted for by White test or Breusch-Pagan test. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement.
Results:
In all, 904 Caucasian Italian healthy children (age 0 days-17 years; 45.5% females; BSA 0.12-2.12m(2)) were prospectively studied. No individual variable provided equations with an acceptable coefficient of determination (R(2)) and even the inclusion of multiple variables in the model resulted in only a partial amelioration of the R(2). Higher R(2) were obtained for PWD-E deceleration time (0.53), septal (Se') and lateral (Le') MV-TDI e' velocity (Se': 0.54; Le': 0.55). Variability was higher at lower age and BSA. In older children patterns were more reproducible; however, the exclusion of neonates did not substantially improve the final models. The low R(2) hampered building of z-scores and calculation of estimated percentiles. Thus normative data have been presented as observed percentile according to age for all measurements.
Conclusions:
We report normal ranges for PWD and TDI mitral velocities derived from a large population of Caucasian children. Variability of diastolic patterns especially at lower ages needs to be taken into account.
