Related Experiment Video
Updated: Mar 8, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study -
Rajendra Kumar Gokhroo1, Avinash Anantharaj1, Devendra Bisht2
1Department of Cardiology, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India.
Insights
This study developed new Z-score nomograms for pediatric echocardiography using Indian children, offering a better reference than Western data for assessing cardiac structures in developing countries.
Area of Science:
- Cardiology
- Pediatric Imaging
- Biostatistics
Background:
- Existing pediatric echocardiography Z-score nomograms primarily use Western data.
- These Western-based nomograms may not accurately represent cardiac structure sizes in children from developing nations.
Purpose of the Study:
- To gather normative cardiovascular data in Indian children aged 4-15 years.
- To create Z-score nomograms for 21 common cardiac structures using M-mode and 2D echocardiography.
Main Methods:
- A community-based sample of 746 healthy Indian school children was assessed.
- Echocardiographic measurements were performed using a Philips iE33 system across two Indian centers.
- Statistical models were used to determine the best fit for plotting Z-score charts based on body surface area.
Main Results:
- Z-score charts were successfully derived for 21 cardiovascular parameters.
- The study identified the most appropriate model relating each parameter to body surface area for nomogram creation.
Conclusions:
- The derived Z-score nomograms may serve as superior references compared to Western nomograms for Indian and other developing countries.
- Further large-scale validation studies are necessary before clinical implementation of these pediatric echocardiography nomograms.
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.
Related Concept Videos
01:17z Scores and Area Under the Curve
01:05Introduction to z Scores
z scores...
01:06Introduction to z Scores
z scores...
01:23Dosage Regimen Designs: Nomograms and Tabulations