Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa

Majonga, Edith; Rehman, Andrea M.; McHugh, Grace; Mujuru, Hilda; Nathoo, Kusum; Patel, Mohammad S.; Munyati, Shungu; Odland, Jon Øyvind; Kranzer, Katharina; Kaski, Juan Pablo; Ferrand, Rashida A

doi:10.1016/j.ijcard.2017.06.109

Cited by 23 publications

(36 citation statements)

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“…Echocardiography measures for LV and right ventricular (RV) dimensions were normalized to body surface area calculated using Du Bois and Du Bois formula [ 17 ], and converted to z -scores using local references [ 18 ] and further compared with European published references among Caucasian children [ 19 ]. Local reference ranges were used as the primary basis for defining cardiac abnormalities in the study.…”

Section: Methodsmentioning

confidence: 99%

High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy

Majonga

Rehman

Simms

et al. 2018

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Background:Antiretroviral therapy (ART) has decreased mortality so that increasing numbers of children with HIV are reaching adolescence. However, longstanding HIV infection and/or its treatment in children is associated with noninfectious complications including cardiac disease. We investigated the prevalence, spectrum and risk factors for echocardiographic abnormalities among children established on ART.Methods:HIV-infected children aged 6–16 years, on ART at least 6 months were enrolled into a cross-sectional study from a public-sector paediatric HIV clinic in Harare, Zimbabwe. A standardized examination including transthoracic echocardiography was performed. Local echocardiographic reference ranges were used to define cardiac abnormalities. Logistic regression was used to examine the association between cardiac abnormalities and risk factors.Results:Of the 201participants recruited, 92 (46%) were girls and median age was 11 (IQR 9–12) years; CD4+ cell count was 727 cells/μl (IQR 473–935) and 154 (78%) had viral load less than 400 copies/ml. Echocardiographic abnormalities were found in 83 (42%); left ventricular (LV) diastolic dysfunction was the most common abnormality 45 (23%) and LV hypertrophy in 22 (11%). LV and left atrial dilatation were found in 9 (5%) and 16 (8%), respectively. Right ventricular dilatation and systolic dysfunction were found in 13 (7%) and 4 (2%), respectively, of whom 60% had concurrent left heart abnormalities. Current use of nevirapine was associated with LVH [aOR 3.14 (1.13–8.72; P = 0.03)] and hypertension was associated with LV diastolic dysfunction [aOR 3.12 (1.48–6.57; P < 0.01)].Conclusion:HIV-infected children established on ART have a high burden of echocardiographic abnormalities. Right heart disease was predominantly associated with left heart abnormalities and may be part of a global cardiomyopathic process. Further studies are needed to investigate the natural history, aetiology, and pathogenesis of these abnormalities, so that appropriate monitoring and treatment strategies can be developed.

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Section: Methodsmentioning

confidence: 99%

High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy

Majonga

Rehman

Simms

et al. 2018

Aids

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“…Only one study each was conducted in South America (Brazil) and Africa (Zimbabwe). Nine studies reported the race of children studied [ 6 , 8 , 9 , 19 , 23 , 25 , 33 , 38 , 39 ]. Sample sizes of the studies ranged from 95 to 9858.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the reference ranges in children were, however, developed in European and North American (US populations) and mainly in Caucasians. Notably, there was only one study each from South America (Brazil) and Africa (Zimbabwe) and the latter was published very recently, implying that most African countries rely on Western references in clinical practice which may not accurately represent black African children [ 6 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Echocardiography plays a critical role in the assessment of cardiac disease. Important differences in echocardiographically derived cardiac chamber dimensions have been previously highlighted in different population groups in adult studies, but this has not been systematically studied in children, whose body size changes throughout childhood. The aim of this study was to review the distribution of available reference ranges for the left cardiac chamber dimensions in older children and adolescents. The following electronic data bases were searched: Medline, Embase and Web of Science were searched to identify studies which have established echocardiographic reference ranges of left heart parameters in children and adolescents from 1975 to December 2017. There was no geographical limitation. All results were imported into Endnote. Retrieved articles were screened and data extracted by two independent reviewers. A total of 4398 studies were retrieved, with 36 studies finally included in this review. 29 (81%) references were from North America and European (Caucasians) populations, with only one study each from Africa and South America. Two-dimensional and M-mode techniques were the most commonly used echocardiography techniques. There were methodological variations in techniques and normalisation of references. Comparison of selected cardiac measures showed significant differences for interventricular septal thickness among Black African, Indian, German and US American children. Available echocardiographic references cannot be generalised to all settings and therefore, there is need for locally relevant reference ranges. Africa and South America are particularly under-represented. Future studies should focus on developing comprehensive echocardiographic reference ranges for children from different racial backgrounds and should use standardised techniques.Electronic supplementary materialThe online version of this article (10.1007/s00246-018-1873-0) contains supplementary material, which is available to authorized users.

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“…transpulmonary-thermodilution, thoracic bioimpedance-bioreactance, ultrasonography). Among them, echocardiography stands out as a method widely used and recommended in clinical practice [3][4][5]. However, different factors contribute to circumscribe the use of echocardiography to certain contexts and conditions, limiting its widespread use (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…for community-based epidemiological studies). Among those factors are: (1) physical (size) restrictions and cost of the devices, (2) operator-dependency and the need for a learning-curve, (3) inability to obtain adequate records in many subjects or conditions, (4) different acquisition approaches may affect measurement variability, (5) a relatively long period of time is required to complete a study and/or (6) ambulatory records or continuous monitoring of the variables cannot be obtained [6,7]. Pulse contour analysis (PCA) of blood pressure (BP) waveforms obtained non-invasively would enable estimating the SV, CO and CI [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Stroke volume and cardiac output non-invasive monitoring based on brachial oscillometry-derived pulse contour analysis: Explanatory variables and reference intervals throughout life (3–88 years)

et al. 2021

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Background: Non-invasive assessment of stroke volume (SV), cardiac output (CO) and cardiac index (CI) has shown to be useful for the evaluation, diagnosis and/or management of different clinical conditions. Through pulse contour analysis (PCA) cuff-based oscillometric devices would enable obtaining ambulatory operator-independent non-invasive hemodynamic monitoring. There are no reference intervals (RIs), when considered as a continuum in childhood, adolescence and adult life, for PCA-derived SV [SV(PCA)], CO [CO(PCA)] and CI [CI(PCA)]. The aim of the study were to analyze the associations of SV(PCA), CO(PCA) and CI(PCA) with demographic, anthropometric, cardiovascular risk factors (CVRFs) and hemodynamic parameters, and to define RIs and percentile curves for SV(PCA), CO(PCA) and CI(PCA), considering the variables that should be considered when expressing them. Methods:In 1449 healthy subjects (3-88 years) SV(PCA), CO(PCA) and CI(PCA) were noninvasively obtained (Mobil-O-Graph; Germany). Analysis: associations between subject characteristics and SV(PCA), CO(PCA) and CI(PCA) levels (correlations; regression models); RIs and percentiles for SV(PCA), CO(PCA) and CI(PCA) (parametric methods; fractional polynomials).Results: Sex, age, and heart rate would be explanatory variables for SV, CO, and CI levels. SV levels were also examined by body height, while body surface area (BSA) contributing to evaluation of CO and CI. CVRFs exposure did not contribute to independently explain the values of the dependent variables. SV, CO and CI levels were partially explained by the oscillometric-derived signal quality. RIs and percentiles were defined. Conclusions:Reference intervals and percentile for SV(PCA), CO(PCA) and CI(PCA), were defined for subjects from 3-88 years of age, results are expressed according to sex, age, heart rate, body height and/or BSA.

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Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa

Cited by 23 publications

References 29 publications

High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy

High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy

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

Stroke volume and cardiac output non-invasive monitoring based on brachial oscillometry-derived pulse contour analysis: Explanatory variables and reference intervals throughout life (3–88 years)

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