State-of-the-Art Review ArticleA Review and Critique of the Statistical Methods Used to Generate Reference Values in Pediatric Echocardiography
Section snippets
Literature Search Strategy
A search of the National Library of Medicine's PubMed database was performed using the Medical Subject Headings controlled vocabulary from the National Library of Medicine. The search strategy was built to retrieve all articles containing the Medical Subject Headings terms “echocardiography” and “reference values” or their equivalents: (reference values OR biometry OR anthropometry OR regression analysis) AND {echocardiography OR [ultrasonography AND (heart OR cardiovascular system)]}. We
Search Results and Selected Articles
The search strategy returned 1,016 articles. Initial screening by title and abstract identified 117 potentially relevant articles. Sixty-five were further excluded (27 did not propose reference values, five were related to other echocardiographic modalities, 20 did not include pediatric data, five did not include normal subjects, and eight were conducted before 1980), leaving 52 articles for analysis.7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31
Discussion
In pediatric and congenital cardiology, many clinical, interventional, and surgical decisions are based on the sizes of cardiac structures. Moreover, follow-up of children with repaired and unrepaired cardiac defects often depends on the identification of structural growth that deviates from expected. The development of reliable and validated reference values in transthoracic echocardiography is thus of great importance, because a biased or inaccurate cardiac growth curve could lead to
Conclusions
Choice of population, technical standardization of echocardiographic measurements, and detailed strategies for model selection were outside the scope of this review, as they were recently addressed elsewhere.6, 59, 61 The recent recommendations of the American Society of Echocardiography on quantification methods in pediatric echocardiography concluded that standardizing quantification methods is the first step in the task of generating a normative database that encompasses the range of body
References (72)
- et al.
Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council
J Am Soc Echocardiogr
(2010) - et al.
Interpretation of echocardiographic measurements: a call for standardization
Am Heart J
(2000) - et al.
Limitations of current echocardiographic nomograms for left ventricular, valvular and arterial dimensions in children: a critical review
J Am Soc Echocardiogr
(2012) - et al.
New equations and a critical appraisal of coronary artery Z scores in healthy children
J Am Soc Echocardiogr
(2011) - et al.
Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease
Am J Cardiol
(1995) - et al.
Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults
J Am Coll Cardiol
(1988) - et al.
Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight
J Am Coll Cardiol
(1992) - et al.
Usefulness of the subaortic diameter for normalizing left ventricular and left atrial dimensions
Am J Cardiol
(1991) - et al.
Nomograms for aortic root diameters in children using two-dimensional echocardiography
Am J Cardiol
(2010) - et al.
Normal right and left ventricular mass development during early infancy
Am J Cardiol
(2004)
Mitral and tricuspid valve anular diameter in normal children determined by two-dimensional echocardiography
Am J Cardiol
Two-dimensional echocardiographic measurement of right pulmonary artery diameter in infants and children
J Am Coll Cardiol
Normal values for left ventricular volume in infants and young children by the echocardiographic subxiphoid five-sixth area by length (bullet) method
J Am Soc Echocardiogr
New perspectives in the assessment of cardiac chamber dimensions during development and adulthood
J Am Coll Cardiol
Coronary artery Z score regression equations and calculators derived from a large heterogeneous population of children undergoing echocardiography
J Am Soc Echocardiogr
Left atrial dimensions in growth and development: normal limits for two-dimensional echocardiography
J Am Coll Cardiol
Limits of normal left ventricular dimensions in growth and development: analysis of dimensions and variance in the two-dimensional echocardiograms of 268 normal healthy subjects
J Am Coll Cardiol
Regression equations for calculation of Z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study
J Am Soc Echocardiogr
Measurement of mitral valve orifice area in infants and children by two-dimensional echocardiography
J Am Coll Cardiol
Two-dimensional echocardiographic aortic root dimensions in normal children and adults
Am J Cardiol
Echocardiographic assessment of aortic root dimensions in normal children based on measurement of a new ratio of aortic size independent of growth
Am J Cardiol
Two-dimensional echocardiographic determination of aortic and pulmonary artery sizes from infancy to adulthood in normal subjects
Am J Cardiol
Range of normal valve annulus size in neonates
Am J Cardiol
Congenital Heart Surgeons Society. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors
J Thorac Cardiovasc Surg
Growth of the human heart relative to body surface area
Am J Cardiol
Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults
J Pediatr
Establishing norms for echocardiographic measurements of cardiovascular structures and function in children
J Appl Physiol
Structural Measurements and adjustment for growth
Normalization of echocardiographically derived paediatric cardiac dimensions to body surface area: time for a standardized approach
Eur J Echocardiogr
Percentile curves of normal values of echocardiographic measurements in normal children from the central-southern region of the State of Sao Paulo, Brazil
Arq Bras Cardiol
A novel method of expressing left ventricular mass relative to body size in children
Circulation
Norms and clinical correlates of echocardiographic left ventricular mass in 3-12 year old children
Indian Heart J
Dimensions of cardiac chambers and great vessels by cross-sectional echocardiography in infants and children
Pediatr Cardiol
Echocardiographic measurements in normal subjects from infancy to old age
Circulation
Cross-sectional study of echocardiographic characteristics in healthy children living at high altitude
Am J Hum Biol
Age and body surface area related normal upper and lower limits of M mode echocardiographic measurements and left ventricular volume and mass from infancy to early adulthood
Br Heart J
Cited by (74)
Normative Echocardiographic Left Ventricular Parameters and Reference Intervals in Infants
2023, Journal of the American College of CardiologyComplexities of Normative Database for Neonatal Echocardiography: The Quest for Perfection Continues
2023, Journal of the American College of CardiologyReference Standards in Quantitative Pediatric Echocardiography: A Guide to the Nuanced World of Z Scores and Nomograms
2023, Journal of the American Society of EchocardiographyAlternative to Body Surface Area as a Solution to Correct Systematic Bias in Pediatric Echocardiography z Scores
2021, Canadian Journal of CardiologyNovel Z Scores to Correct Biases Due to Ventricular Volume Indexing to Body Surface Area in Adolescents and Young Adults
2021, Canadian Journal of CardiologyPediatric Heart Network Echocardiographic Z Scores: Comparison with Other Published Models
2021, Journal of the American Society of Echocardiography