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Updated: Feb 15, 2026

In vitro Assessment of Cardiac Reprogramming by Measuring Cardiac Specific Calcium Flux with a GCaMP3 Reporter
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The Ratio Fallacy, with Special Reference to the Cardiac Index.

Julien I E Hoffman1

  • 1Department of Pediatrics, University of California, 925 Tiburon Boulevard, Tiburon, San Francisco, CA, 94920, USA. jiehoffman@gmail.com.

Pediatric Cardiology
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Summary

Cardiac index calculations can be inaccurate for infants. Determining z values is a more reliable method for evaluating cardiac output in children of all sizes.

Keywords:
Body surface areaCardiac indexCardiac output

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Area of Science:

  • Pediatric Cardiology
  • Physiology

Background:

  • Cardiac output is frequently normalized to body surface area (BSA) using the cardiac index for comparisons.
  • The cardiac index may introduce significant errors when assessing cardiac output in small infants.

Purpose of the Study:

  • To highlight the limitations of the cardiac index in pediatric populations.
  • To propose an alternative method for evaluating cardiac output in children.

Main Methods:

  • Review of existing methodologies for cardiac output assessment in pediatrics.
  • Analysis of the accuracy of cardiac index versus z values for different pediatric age groups.

Main Results:

  • The cardiac index demonstrates potential for large errors in small infants.
  • Z values provide a more accurate and reliable assessment of cardiac output across diverse pediatric sizes.

Conclusions:

  • The use of z values is recommended for evaluating cardiac output in children, particularly infants.
  • Relying on the cardiac index for neonates and small infants may lead to misinterpretations of cardiovascular status.