Frederic Dallaire1, Cameron Slorach2, Wei Hui2, Taisto Sarkola2, Mark K Friedberg2, Timothy J Bradley2, Edgar Jaeggi2, Andreea Dragulescu2, Ronnie L H Har2, David Z I Cherney2, Luc Mertens2. 1. From the Division of Pediatric Cardiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada (F.D.); Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.D.); The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., W.H., T.S., M.K.F., T.J.B., E.J., A.D., L.M.); and Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Ontario, Canada (R.L.H.H., D.Z.I.C.). frederic.a.dallaire@usherbrooke.ca. 2. From the Division of Pediatric Cardiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada (F.D.); Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.D.); The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., W.H., T.S., M.K.F., T.J.B., E.J., A.D., L.M.); and Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Ontario, Canada (R.L.H.H., D.Z.I.C.).
Abstract
BACKGROUND: In pediatric echocardiography, pulse wave Doppler, and tissue Doppler imaging velocities are widely used to assess cardiac function. Current reference values and Z scores, allowing adjustment for growth are limited by inconsistent methodologies and small sample size. Using a standardized approach for parametric modeling and Z score quality assessment, we propose new pediatric reference values and Z score equations for most left ventricular pulse wave Doppler and tissue Doppler imaging measurements. METHODS AND RESULTS: Two hundred thirty-three healthy pediatric subjects 1 to 18 years of age were prospectively recruited. Thirteen pulse wave Doppler and 14 tissue Doppler imaging measurements were recorded. Normalization for growth was done via a complete and standardized approach for parametric nonlinear regression modeling. Several analyses were performed to ensure adequate Z score distribution and to detect potential residual associations with growth or residual heteroscedasticity. Most measurements adopted a nonlinear relationship with growth and displayed significant heteroscedasticity. Compared with age, height, and weight, normalization for body surface area was most efficient in removing the effect of growth. Generally, polynomial and allometric models yielded adequate goodness-of-fit. Residual values for several measurements had significant departure from the normal distribution, which could be corrected using logarithmic or reciprocal transformation. Overall, weighted parametric nonlinear models allowed us to compute Z score equations with adequate normal distribution and without residual association with growth. CONCLUSIONS: We present Z scores for normalized pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Further studies are needed to define the threshold beyond which health becomes a disease by integrating other important factors such as ventricular morphology, loading conditions, and heart rate.
BACKGROUND: In pediatric echocardiography, pulse wave Doppler, and tissue Doppler imaging velocities are widely used to assess cardiac function. Current reference values and Z scores, allowing adjustment for growth are limited by inconsistent methodologies and small sample size. Using a standardized approach for parametric modeling and Z score quality assessment, we propose new pediatric reference values and Z score equations for most left ventricular pulse wave Doppler and tissue Doppler imaging measurements. METHODS AND RESULTS: Two hundred thirty-three healthy pediatric subjects 1 to 18 years of age were prospectively recruited. Thirteen pulse wave Doppler and 14 tissue Doppler imaging measurements were recorded. Normalization for growth was done via a complete and standardized approach for parametric nonlinear regression modeling. Several analyses were performed to ensure adequate Z score distribution and to detect potential residual associations with growth or residual heteroscedasticity. Most measurements adopted a nonlinear relationship with growth and displayed significant heteroscedasticity. Compared with age, height, and weight, normalization for body surface area was most efficient in removing the effect of growth. Generally, polynomial and allometric models yielded adequate goodness-of-fit. Residual values for several measurements had significant departure from the normal distribution, which could be corrected using logarithmic or reciprocal transformation. Overall, weighted parametric nonlinear models allowed us to compute Z score equations with adequate normal distribution and without residual association with growth. CONCLUSIONS: We present Z scores for normalized pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Further studies are needed to define the threshold beyond which health becomes a disease by integrating other important factors such as ventricular morphology, loading conditions, and heart rate.
Authors: Philip T Levy; Aliza Machefsky; Aura A Sanchez; Meghna D Patel; Sarah Rogal; Susan Fowler; Lauren Yaeger; Angela Hardi; Mark R Holland; Aaron Hamvas; Gautam K Singh Journal: J Am Soc Echocardiogr Date: 2015-12-30 Impact factor: 5.251
Authors: Alexander Ruh; Roberto Sarnari; Haben Berhane; Kenny Sidoryk; Kai Lin; Ryan Dolan; Arleen Li; Michael J Rose; Joshua D Robinson; James C Carr; Cynthia K Rigsby; Michael Markl Journal: Int J Cardiovasc Imaging Date: 2019-02-04 Impact factor: 2.357
Authors: Charlotte Gimpel; Bernd A Jung; Sabine Jung; Johannes Brado; Daniel Schwendinger; Barbara Burkhardt; Martin Pohl; Katja E Odening; Julia Geiger; Raoul Arnold Journal: Pediatr Radiol Date: 2016-12-13
Authors: Wadi Mawad; Luc Mertens; Joseph J Pagano; Eugenie Riesenkampff; Marjolein J E Reichert; Seema Mital; Paul F Kantor; Mark Greenberg; Peter Liu; Paul C Nathan; Lars Grosse-Wortmann Journal: Eur Heart J Cardiovasc Imaging Date: 2021-03-22 Impact factor: 6.875
Authors: Andrew W McCrary; Winstone M Nyandiko; Alicia M Ellis; Hrishikesh Chakraborty; Michael J Muehlbauer; Myra M Koech; Ibrahim Daud; Elcy Birgen; Nathan M Thielman; Joseph A Kisslo; Piers C A Barker; Gerald S Bloomfield Journal: AIDS Date: 2020-03-15 Impact factor: 4.632