A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study – The Z-score

Echocardiographic reference z scores of right ventricular dimension and systolic function of children aged 5–12 years

“…The mean values of all the right ventricular dimensions obtained were higher than those obtained in Australian children 6) within the same age bracket. Similarly, the mean values were higher than values reported in children with equivalent BSA in India 10) and Italy. 9) The reason for these variations may be due to genetic and racial differences in cardiac sizes.…”

“…The strength of our study is the relatively large sample. Our study was also school-based, similar TO that carried out by Gokhroo et al 10) In contrast, most of the other studies [7][8][9]23) were hospital-based and involved subjects referred for cardiac evaluation. The school is a better reflection of the general population than the hospital; measurements from hospital settings are less repre sentative of the general population and may be biased by children with asymptomatic but abnormal cardiac findings.…”

“…11) The comparison of z score-based scatter plots for right ventricular dimensions and systolic function with other studies is limited. This is because only a few studies generated z score scatter plots 6,11) while others had charts and curves plotted for z score [7][8][9][10]24) using BSA and the measurements obtained. In addition, some of the studies obtained the z score based reference values using various regression models 6,7,[9][10][11] while others did not use regression models.…”

“…This is because only a few studies generated z score scatter plots 6,11) while others had charts and curves plotted for z score [7][8][9][10]24) using BSA and the measurements obtained. In addition, some of the studies obtained the z score based reference values using various regression models 6,7,[9][10][11] while others did not use regression models. 8,23,24) In computing z scores, a regression model should be selected so that the fit is adequate across the whole population to avoid heteroscedasticity.…”

“…Published reference values for right ventricular size and sys tolic function are available in some countries including Australia, Spain, Turkey, Italy, India, and Zimbabwe. [6][7][8][9][10][11] There is a likelihood of misinterpretation if reference values from other countries are used in our population due to differences in genetic, environmental, socio-economic, and anthropometric determinants of cardiac size. 12) For instance, Gokhroo et al 10) found that most of the right ventricular dimension parameters of Indian children were smaller than those of their Western counterparts.…”