A pediatric echocardiographic Z-score nomogram for a developing country

Abstract

Background:Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries.Objective:This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each.Subjects and Methods:The study was conducted at two centers in India - Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system.Results and Analysis:For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived.Conclusions:The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.

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

“…We thank the author for his keen interest in our study[ 1 ] and his valuable response for the same. [ 2 ] We read with utmost interest the four issues put forth by the author and wish to provide relevant clarifications.…”

Racial Variation in Echocardiographic Reference Ranges for Left Chamber Dimensions in Children and Adolescents: A Systematic Review

“…LA diameter references were established in twelve studies, six of which were conducted in US American children [ 16 , 28 , 30 , 38 , 39 ]. LA length references were from Indian, Italian and Swedish children and of these, two studies also reported data on LA area [ 5 , 9 , 32 ]. LA volume was derived in four studies and three of these were in US American children (Table 3 ) [ 12 , 14 , 21 , 30 ].…”

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

“…on the constructing pediatric echocardiographic Z -score nomogram in India. [ 1 ] Apart from a few limitations addressed by the authors, I presume that the following four limitations might additionally cast some suspicions on the study results and possibly introduce bias in the clinical decision-making process.…”

“…First, in the methodology, the authors stated that various echocardiographic measurements were expressed in relation to body surface area (BSA) calculated by Haycock's formula (BSA = weight 0.5378 × height 0.3964 × 0.024265). [ 1 ] It is worthy to mention that various formula are present in the clinical settings to calculate BSA, namely, Boyd, Mosteller, Gehan and George, Haycock, and Dubois-DuBois. Clinical evaluation revealed the different performance of each BSA estimation method in certain pediatric population.…”

“…The two-dimensional echocardiography and M-mode measurements of various cardiovascular structures were obtained for each participant. [ 1 ] It is noteworthy that the recent developments in three-dimensional echocardiography (3DE) have resulted in smaller probes, faster data acquisition, and wider applicability. A systematic literature search has pointed that in patients with a regular heart rhythm and for whom it was possible to obtain good quality images, the introduction of 3DE has improved the accuracy and reproducibility of the left ventricular volume and ejection fraction measurements.…”