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Aortic size in children: Systolic measurements are different from diastolic measurements
Mohammad F Al-Mousily1,2, Leo Lopez1,3, Juan Carlos Muniz1
1Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA.
Insights
Systolic aortic measurements in children are larger than diastolic measurements for the aortic root, sinotubular junction, and ascending aorta. These findings impact pediatric cardiology reference values.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Aortic Anatomy
Background:
- Current guidelines recommend different aortic measurement timings for children and adults.
- Adult studies show significant systolic-diastolic differences in aortic dimensions.
- This study investigates these differences in healthy children.
Purpose of the Study:
- To characterize systolic and diastolic differences in aortic measurements in healthy children.
- To evaluate the clinical significance of these differences.
- To inform appropriate reference value selection in pediatric cardiology.
Main Methods:
- Retrospective analysis of 272 children's echocardiograms.
- Measurement of aortic annulus, root, sinotubular junction, and ascending aorta.
- Calculation of systolic-to-diastolic percent difference, with >5% considered significant.
Main Results:
- Systolic measurements were significantly larger than diastolic measurements for the aortic root, sinotubular junction, and ascending aorta (P < 0.001).
- Clinically significant differences (>5%) were observed in these segments.
- No significant difference was found for the aortic annulus.
- Excellent inter-observer agreement was achieved (ICC 0.982-0.995).
Conclusions:
- Systolic aortic dimensions are larger than diastolic in children for key segments.
- Measurement timing should align with clinical practice for accurate reference values.
- This is crucial for managing pediatric patients transitioning to adult care.
Background:
Current guidelines recommended aortic measurements during diastole in adults and during systole in children. Recent studies in adults have demonstrated noteworthy differences in aortic measurements during systole and diastole in the same subjects. In the present study, we aimed to characterize systolic and diastolic differences in aortic measurements in healthy children.
Materials And Methods:
This retrospective study included 272 children who had a complete echocardiogram and no heart disease. Aortic measurements at the annulus (ANN), aortic root (AOR), sinotubular junction (STJ), and ascending aorta (AAO) were performed. Systolic and diastolic values were compared by calculating the mean systolic to diastolic (SD) percent difference for each segment; if the SD difference was >5%, it was considered clinically important. Similar measurements were conducted by another observer in 18% of the subjects.
Results:
Systolic measurements were larger than diastolic measurements with mean SD percent differences >5% (P < 0.001) for the AOR (7.3% ± 5.5%), STJ (10.24% ± 7.1%), and AAO (9.8% ± 7.4%). There was no clinically significant SD difference for the ANN. There was an excellent intraclass correlation coefficient between observers (0.982-0.995).
Conclusions:
Systolic measurements for the AOR, STJ, and AAO were larger than diastolic measurements. Normal reference values are utilized to design treatment for patients with abnormal aortic sizes, and the timing in the cardiovascular cycle used to decide the reference values should be equivalent to the timing used to make measurements in clinical practice. This is particularly imperative as patients transition their care from a pediatric to an adult cardiologist.
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