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Height Versus Body Surface Area to Normalize Cardiovascular Measurements in Children Using the Pediatric Heart
Joseph Mahgerefteh1,2, Wyman Lai3, Steven Colan4
1Children's Hospital at Montefiore, New York, NY, USA. Joseph.Mahgerefteh@mssm.edu.
Insights
Height-based normalization for pediatric cardiovascular measurements is feasible, but impacts Z-scores differently across body mass index (BMI) ranges compared to body surface area (BSA) normalization.
Area of Science:
- Pediatric Cardiology
- Biometry
- Medical Imaging Analysis
Background:
- Accurate normalization of cardiovascular measurements is crucial for comparing children and identifying pathological changes.
- Growing interest exists in utilizing height for normalizing pediatric cardiovascular data.
- Body surface area (BSA) has been the traditional method for normalization.
Purpose of the Study:
- To develop and compare height-based normalization models with BSA-based models for aortic and left ventricular (LV) measurements in children.
- To evaluate the impact of different normalization methods on Z-scores across varying body mass index (BMI) categories.
Main Methods:
- Utilized echocardiographic data from healthy children aged 2-18 years from the Pediatric Heart Network Echo Z-Score Project.
- Calculated Z-scores for proximal aortic diameters, LV end-diastolic volume, and LV mass using both height-based and BSA-based allometric normalization.
- Assessed relationships between Z-scores and demographic factors (age, sex, race, ethnicity) and BMI.
Main Results:
- Height-based and BSA-based normalization models for aortic and LV sizes are feasible in children.
- No significant relationships were found between Z-scores and age, sex, race, or ethnicity.
- Height-based normalization yielded lower Z-scores in underweight children and higher Z-scores in overweight children compared to BSA-based normalization.
Conclusions:
- Both height and BSA normalization are viable for pediatric cardiovascular measurements.
- Height-based normalization leads to higher Z-scores in heavier children, while BSA-based normalization favors lighter children.
- Further research is needed to validate these methods in obese children, with and without cardiac conditions.
Abstract:
Normalizing cardiovascular measurements for body size allows for comparison among children of different ages and for distinguishing pathologic changes from normal physiologic growth. Because of growing interest to use height for normalization, the aim of this study was to develop height-based normalization models and compare them to body surface area (BSA)-based normalization for aortic and left ventricular (LV) measurements. The study population consisted of healthy, non-obese children between 2 and 18 years of age enrolled in the Pediatric Heart Network Echo Z-Score Project. The echocardiographic study parameters included proximal aortic diameters at 3 locations, LV end-diastolic volume, and LV mass. Using the statistical methodology described in the original project, Z-scores based on height and BSA were determined for the study parameters and tested for any clinically significant relationships with age, sex, race, ethnicity, and body mass index (BMI). Normalization models based on height versus BSA were compared among underweight, normal weight, and overweight (but not obese) children in the study population. Z-scores based on height and BSA were calculated for the 5 study parameters and revealed no clinically significant relationships with age, sex, race, and ethnicity. Normalization based on height resulted in lower Z-scores in the underweight group compared to the overweight group, whereas normalization based on BSA resulted in higher Z-scores in the underweight group compared to the overweight group. In other words, increasing BMI had an opposite effect on height-based Z-scores compared to BSA-based Z-scores. Allometric normalization based on height and BSA for aortic and LV sizes is feasible. However, height-based normalization results in higher cardiovascular Z-scores in heavier children, and BSA-based normalization results in higher cardiovascular Z-scores in lighter children. Further studies are needed to assess the performance of these approaches in obese children with or without cardiac disease.
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