Comprehensive Two-Dimensional Pediatric Echocardiographic Nomograms for Coronary Artery Sizes in Caucasian Children and Comparison among Major Nomograms
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Published on: January 27, 2023
Massimiliano Cantinotti1,2, Marco Scalese3, Francesca Valeria Contini4
1Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy.
Insights
This study provides normal coronary artery diameters for healthy Caucasian children, establishing new reference ranges. These findings offer valuable data for pediatric cardiology assessments and comparisons with existing nomograms.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Biostatistics
Background:
- Existing coronary artery nomograms lack data for Caucasian children.
- Accurate pediatric coronary artery measurements are crucial for diagnosing and managing cardiovascular conditions.
Purpose of the Study:
- To establish a comprehensive dataset of normal coronary artery diameters in healthy Caucasian children.
- To compare these new measurements with existing major nomograms.
- To provide updated reference ranges for pediatric cardiology.
Main Methods:
- Prospective evaluation of 606 healthy children (1 day to 18 years).
- Coronary artery measurements performed using short-axis view echocardiography.
- Age, heart rate, and body surface area (BSA) analyzed as predictors; logarithmic models used for normalization.
Main Results:
- Body surface area (BSA) showed the strongest association for data normalization.
- Logarithmic models (ln[y] = a + b*ln[x]) provided the best fit.
- New normal ranges were established, slightly lower than some existing nomograms, with specific Z-score deviations for left and right coronary arteries.
Conclusions:
- A complete dataset of normal echocardiography coronary artery diameters in healthy children is presented.
- The new data includes proximal origin measurements.
- Statistical comparison indicates similarity to North American nomograms, providing updated pediatric reference values.
Background:
Although coronary artery nomograms in children have been published, data on Caucasian children are lacking. The aim of this study is to provide: (i) a full dataset of coronary artery diameters in healthy children and (ii) a comparison among major previous nomograms.
Materials And Methods:
We prospectively evaluated 606 healthy subjects (age range, 1 days-<18 years; median age 8.7 years; 62.5% male). Coronary artery measurements in a short-axis view were performed. Age, heart rate, and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. To assess the accuracy of the predictive models of different studies, a Z-score calculator was created using Lopez's nomograms for comparison.
Results:
The association with BSA was found to be stronger, and was used for normalization of our data. The best-fit models, satisfying the assumption of homoscedasticity and normality of residuals and showing the highest R2 scores, were logarithmic (ln[y] = a + b*ln[x]). Predicted values and Z-score boundaries by BSA are provided. Our ranges of normality are slightly lower than those, diverging from -0.22 to -0.59 Z-scores for the left main coronary artery and from -0.23 to -0.3 Z-scores for the right coronary artery.
Conclusions:
We report a complete dataset of normal echocardiography coronary artery diameter (including new measures of the proximal origin) values in a large population of healthy children. Our data were statistically like those of north American nomograms.
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