Leo Lopez1, Peter C Frommelt2, Steven D Colan3, Felicia L Trachtenberg4, Russell Gongwer4, Mario Stylianou5, Aarti Bhat6, Kristin M Burns5, Meryl S Cohen7, Andreea Dragulescu8, Lindsay R Freud9, Michele A Frommelt2, Irene D Lytrivi9, Joseph Mahgerefteh10, Brian W McCrindle8, Ricardo Pignatelli11, Ashwin Prakash3, Ritu Sachdeva12, Jonathan H Soslow13, Christopher Spurney14, Carolyn L Taylor15, Poonam P Thankavel16, Thor Thorsson17, Justin T Tretter18, Luciana T Young19, L LuAnn Minich20. 1. Stanford University School of Medicine, Palo Alto, California. Electronic address: leolopezmd@gmail.com. 2. Children's Hospital of Wisconsin, Milwaukee, Wisconsin. 3. Boston Children's Hospital, Boston, Massachusetts. 4. New England Research Institutes, Watertown, Massachusetts. 5. National Heart, Lung, and Blood Institute, Bethesda, Maryland. 6. Seattle Children's Hospital, Seattle, Washington. 7. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 8. Hospital for Sick Children, Toronto, Ontario, Canada. 9. Children's Hospital of New York, New York, New York. 10. Children's Hospital at Montefiore, New York, New York. 11. Texas Children's Hospital, Houston, Texas. 12. Children's Healthcare of Atlanta, Atlanta, Georgia. 13. Vanderbilt University Medical Center, Nashville, Tennessee. 14. Children's National Health System, Washington, District of Columbia. 15. Medical University of South Carolina, Charleston, South Carolina. 16. University of Texas Southwestern, Dallas, Texas. 17. CS Mott Children's Hospital, Ann Arbor, Michigan. 18. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 19. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 20. University of Utah, Salt Lake City, Utah.
Abstract
BACKGROUND: Different methods have resulted in variable Z scores for echocardiographic measurements. Using the measurements from 3,215 healthy North American children in the Pediatric Heart Network (PHN) echocardiographic Z score database, the authors compared the PHN model with previously published Z score models. METHODS: Z scores were derived for cardiovascular measurements using four models (PHN, Boston, Italy, and Detroit). Model comparisons were performed by evaluating (1) overlaid graphs of measurement versus body surface area with curves at Z = -2, 0, and +2; (2) scatterplots of PHN versus other Z scores with correlation coefficients; (3) Bland-Altman plots of PHN versus other Z scores; and (4) comparison of median Z scores for each model. RESULTS: For most measurements, PHN Z score curves were similar to Boston and Italian curves but diverged from Detroit curves at high body surface areas. Correlation coefficients were high when comparing the PHN model with the others, highest with Boston (mean, 0.99) and lowest with Detroit (mean, 0.90). Scatterplots suggested systematic differences despite high correlations. Bland-Altman plots also revealed poor agreement at both extremes of size and a systematic bias for most when comparing PHN against Italian and Detroit Z scores. There were statistically significant differences when comparing median Z scores between the PHN and other models. CONCLUSIONS: Z scores from the multicenter PHN model correlated well with previous single-center models, especially the Boston model, which also had a large sample size and similar methodology. The Detroit Z scores diverged from the PHN Z scores at high body surface area, possibly because there were more subjects in this category in the PHN database. Despite excellent correlation, significant differences in Z scores between the PHN model and others were seen for many measurements. This is important when comparing publications using different models and for clinical care, particularly when Z score thresholds are used to guide diagnosis and management.
BACKGROUND: Different methods have resulted in variable Z scores for echocardiographic measurements. Using the measurements from 3,215 healthy North American children in the Pediatric Heart Network (PHN) echocardiographic Z score database, the authors compared the PHN model with previously published Z score models. METHODS: Z scores were derived for cardiovascular measurements using four models (PHN, Boston, Italy, and Detroit). Model comparisons were performed by evaluating (1) overlaid graphs of measurement versus body surface area with curves at Z = -2, 0, and +2; (2) scatterplots of PHN versus other Z scores with correlation coefficients; (3) Bland-Altman plots of PHN versus other Z scores; and (4) comparison of median Z scores for each model. RESULTS: For most measurements, PHN Z score curves were similar to Boston and Italian curves but diverged from Detroit curves at high body surface areas. Correlation coefficients were high when comparing the PHN model with the others, highest with Boston (mean, 0.99) and lowest with Detroit (mean, 0.90). Scatterplots suggested systematic differences despite high correlations. Bland-Altman plots also revealed poor agreement at both extremes of size and a systematic bias for most when comparing PHN against Italian and Detroit Z scores. There were statistically significant differences when comparing median Z scores between the PHN and other models. CONCLUSIONS: Z scores from the multicenter PHN model correlated well with previous single-center models, especially the Boston model, which also had a large sample size and similar methodology. The Detroit Z scores diverged from the PHN Z scores at high body surface area, possibly because there were more subjects in this category in the PHN database. Despite excellent correlation, significant differences in Z scores between the PHN model and others were seen for many measurements. This is important when comparing publications using different models and for clinical care, particularly when Z score thresholds are used to guide diagnosis and management.
Authors: Irene D Lytrivi; Puneet Bhatla; H Helen Ko; Jen Yau; Miwa K Geiger; Rowan Walsh; Ira A Parness; Shubhika Srivastava; James C Nielsen Journal: J Am Soc Echocardiogr Date: 2011-02 Impact factor: 5.251
Authors: Arvind Hoskoppal; Shaji Menon; Felicia Trachtenberg; Kristin M Burns; Julie De Backer; Bruce D Gelb; Marie Gleason; Jeanne James; Wyman W Lai; Aimee Liou; Lynn Mahony; Aaron K Olson; Reed E Pyeritz; Angela M Sharkey; Mario Stylianou; Stephanie Burns Wechsler; Luciana Young; Jami C Levine; Elif Seda Selamet Tierney; Ronald V Lacro; Timothy J Bradley Journal: Pediatr Cardiol Date: 2018-06-11 Impact factor: 1.655
Authors: Mary Beth F Son; Kimberlee Gauvreau; Adriana H Tremoulet; Mindy Lo; Annette L Baker; Sarah de Ferranti; Fatma Dedeoglu; Robert P Sundel; Kevin G Friedman; Jane C Burns; Jane W Newburger Journal: J Am Heart Assoc Date: 2019-06-04 Impact factor: 5.501
Authors: Dianna M Milewicz; Alan C Braverman; Julie De Backer; Shaine A Morris; Catherine Boileau; Irene H Maumenee; Guillaume Jondeau; Arturo Evangelista; Reed E Pyeritz Journal: Nat Rev Dis Primers Date: 2021-09-02 Impact factor: 65.038