Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity

The Pediatric Heart Network Normal Echocardiogram Database

Pediatric Heart Network Investigators*

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity.

METHODS AND RESULTS: Data collected from healthy nonobese children ≤18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSAα) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5% difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as ≥5% difference. Of the 3566 subjects, 90% had measurable images. Appropriate BSA transformations (BSAα) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement.

CONCLUSIONS: Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.

Original languageEnglish (US)
JournalCirculation. Cardiovascular imaging
Volume10
Issue number11
DOIs
StatePublished - Nov 1 2017

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Body Surface Area
Databases
Pediatrics
Nomograms
Observer Variation
Sample Size
Multicenter Studies
Weights and Measures
Population

Keywords

  • body surface area
  • echocardiography
  • heart
  • nomograms
  • sample size

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{2819182e7e5344e4a4d722cb8e046566,
title = "Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database",
abstract = "BACKGROUND: Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity.METHODS AND RESULTS: Data collected from healthy nonobese children ≤18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSAα) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5{\%} difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as ≥5{\%} difference. Of the 3566 subjects, 90{\%} had measurable images. Appropriate BSA transformations (BSAα) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement.CONCLUSIONS: Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.",
keywords = "body surface area, echocardiography, heart, nomograms, sample size",
author = "{Pediatric Heart Network Investigators*} and Leo Lopez and Steven Colan and Mario Stylianou and Suzanne Granger and Felicia Trachtenberg and Peter Frommelt and Gail Pearson and Joseph Camarda and James Cnota and Meryl Cohen and Andreea Dragulescu and Michele Frommelt and Olukayode Garuba and Tiffanie Johnson and Wyman Lai and Joseph Mahgerefteh and Ricardo Pignatelli and Ashwin Prakash and Ritu Sachdeva and Brian Soriano and Jonathan Soslow and Christopher Spurney and Shubhika Srivastava and Carolyn Taylor and Poonam Thankavel and {van der Velde}, Mary and Minich, {Lu Ann}",
year = "2017",
month = "11",
day = "1",
doi = "10.1161/CIRCIMAGING.117.006979",
language = "English (US)",
volume = "10",
journal = "Circulation: Cardiovascular Imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity

T2 - The Pediatric Heart Network Normal Echocardiogram Database

AU - Pediatric Heart Network Investigators

AU - Lopez, Leo

AU - Colan, Steven

AU - Stylianou, Mario

AU - Granger, Suzanne

AU - Trachtenberg, Felicia

AU - Frommelt, Peter

AU - Pearson, Gail

AU - Camarda, Joseph

AU - Cnota, James

AU - Cohen, Meryl

AU - Dragulescu, Andreea

AU - Frommelt, Michele

AU - Garuba, Olukayode

AU - Johnson, Tiffanie

AU - Lai, Wyman

AU - Mahgerefteh, Joseph

AU - Pignatelli, Ricardo

AU - Prakash, Ashwin

AU - Sachdeva, Ritu

AU - Soriano, Brian

AU - Soslow, Jonathan

AU - Spurney, Christopher

AU - Srivastava, Shubhika

AU - Taylor, Carolyn

AU - Thankavel, Poonam

AU - van der Velde, Mary

AU - Minich, Lu Ann

PY - 2017/11/1

Y1 - 2017/11/1

N2 - BACKGROUND: Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity.METHODS AND RESULTS: Data collected from healthy nonobese children ≤18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSAα) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5% difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as ≥5% difference. Of the 3566 subjects, 90% had measurable images. Appropriate BSA transformations (BSAα) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement.CONCLUSIONS: Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.

AB - BACKGROUND: Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity.METHODS AND RESULTS: Data collected from healthy nonobese children ≤18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSAα) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5% difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as ≥5% difference. Of the 3566 subjects, 90% had measurable images. Appropriate BSA transformations (BSAα) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement.CONCLUSIONS: Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.

KW - body surface area

KW - echocardiography

KW - heart

KW - nomograms

KW - sample size

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U2 - 10.1161/CIRCIMAGING.117.006979

DO - 10.1161/CIRCIMAGING.117.006979

M3 - Article

VL - 10

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

SN - 1941-9651

IS - 11

ER -