Faculty Collaboration Database

Height Versus Body Surface Area to Normalize Cardiovascular Measurements in Children Using the Pediatric Heart Network Echocardiographic Z-Score Database. Pediatr Cardiol 2021 Aug;42(6):1284-1292

Date

04/21/2021

Pubmed ID

33877418

Pubmed Central ID

PMC8684290

DOI

10.1007/s00246-021-02609-x

Scopus ID

2-s2.0-85104623949 (requires institutional sign-in at Scopus site)   5 Citations

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.

Author List

Mahgerefteh J, Lai W, Colan S, Trachtenberg F, Gongwer R, Stylianou M, Bhat AH, Goldberg D, McCrindle B, Frommelt P, Sachdeva R, Shuplock JM, Spurney C, Troung D, Cnota JF, Camarda JA, Levine J, Pignatelli R, Altmann K, van der Velde M, Thankavel PP, Chowdhury S, Srivastava S, Johnson TR, Lopez L, Pediatric Heart Network Investigators

Author

Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Body Height
Body Surface Area
Cardiovascular Diseases
Child
Child, Preschool
Databases, Factual
Echocardiography
Female
Heart
Humans
Male
Pediatric Obesity
Pediatrics
Reference Values