Clinical Investigation
Echocardiography in Children and Fetuses
New Reference Centiles for Left Ventricular Mass Relative to Lean Body Mass in Children

https://doi.org/10.1016/j.echo.2015.12.011Get rights and content

Background

Echocardiographic measurement of left ventricular (LV) mass is routinely performed in pediatric patients with elevated cardiovascular risk. The complex relationship between heart growth and body growth in children requires normalization of LV mass to determine its appropriateness relative to body size. LV mass is strongly determined by lean body mass (LBM). Using new LBM predictive equations, the investigators generated sex-specific LV mass-for-LBM centile curves for children 5 to 18 years of age.

Methods

This retrospective study used M-mode echocardiographic data collected from 1995 through 2003 from 939 boys and 771 girls between 5 and 18 years of age (body mass index < 85th percentile for sex and age) to create smoothed sex-specific LV mass-for-LBM reference centile curves using the Lamda Mu Sigma method. The newly developed reference centiles were applied to children with essential hypertension and with chronic kidney disease, groups known to be at high risk for LV hypertrophy (LVH). The identification of LVH using two different normalization approaches was compared: LV mass-for-LBM and LV mass index-for-age percentiles.

Results

Among 231 children at risk for LVH, on average, relative LV mass was higher using the LV mass index-for-age percentile method than the LV mass-for-LBM percentile method. LVH was more likely to be diagnosed among overweight children and less likely among thin children.

Conclusions

This study provides new LV mass reference centiles expressing LV mass relative to LBM, the strongest determinant of LV mass. These reference centiles may allow more accurate stratification of cardiovascular risk in children.

Section snippets

Methods

This retrospective study was conducted using echocardiograms of children previously participating in the development of normative values for LV mass at Cincinnati Children's Hospital Medical Center (CCHMC).5 This is the largest and most commonly used reference data set. We also used the echocardiograms of children previously participating in prior research protocols conducted at CCHMC as well as studies done for clinical purposes at the Montreal Children's Hospital.24, 25, 26 All research

LV Mass-for-LBM Reference Centiles

There were 939 boys and 771 girls between 5 and 18 years of age in the healthy group used to create the LV mass-for-LBM reference centiles. The characteristics of these children are summarized in Table 1. We initially created a single set of LV mass-for-LBM centile curves including both boys and girls. However, there were significant differences in the LV mass-for-LBM Z-score distributions for healthy reference boys and girls (mean, +0.06 ± 0.03 for boys and −0.08 ± 0.04 for girls; P = .004). A

Discussion

LV mass is strongly determined by LBM.6, 8, 10, 15, 36 Because of difficulties in measuring LBM, previous studies have used height, weight, and BSA as surrogates for LBM to normalize LV mass.4, 5, 21 However, these LBM surrogates have important limitations. Although height has been proposed as the most suitable scaling variable, scaling LV mass to height was recently shown to result in underestimation of relative LV mass in thin individuals and overestimation among overweight individuals.6 This

Conclusions

Notwithstanding the above limitations, these LV mass-for-LBM reference centiles represent a significant advance, potentially allowing more accurate identification of LVH in children. We expect that these reference curves will become the new reference standard for both research and clinical echocardiography.

Acknowledgment

We thank Dr. Robert Platt for assistance in generating the graphical representations of the centile curves.

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    Dr. Foster, a member of the McGill University Health Centre Research Institute (supported in part by Fonds de la Recherche du Québec Santé [FRQS]), was supported by FRQS. Dr. Mitsnefes is supported by grant K24DK090070 from the National Institutes of Health.

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