Clinical InvestigationEchocardiography in Children and FetusesNew Reference Centiles for Left Ventricular Mass Relative to Lean Body Mass 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.
References (48)
- et al.
Mild dilated cardiomyopathy and increased left ventricular mass predict mortality: the prospective P2C2 HIV Multicenter Study
Am Heart J
(2005) - et al.
Age-specific reference intervals for indexed left ventricular mass in children
J Am Soc Echocardiogr
(2009) - et al.
Limitations of expressing left ventricular mass relative to height and to body surface area in children
J Am Soc Echocardiogr
(2013) - et al.
Different normalizations for body size and population attributable risk of left ventricular hypertrophy: the MAVI study
Am J Hypertens
(2005) - et al.
Magnetic-resonance-imaging-derived indices for the normalization of left ventricular morphology by body size
Magn Reson Imaging
(2009) - 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.
The associations of body size and body composition with left ventricular mass: impacts for indexation in adults
J Am Coll Cardiol
(1998) - et al.
Allometric normalization of cardiac measures: producing better, but imperfect, accuracy
J Am Soc Echocardiogr
(2014) - et al.
Abnormal cardiac function in children after renal transplantation
Am J Kidney Dis
(2004) - et al.
Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study
J Pediatr
(2006)
Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults
J Am Coll Cardiol
Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings
Am J Cardiol
Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk
J Am Coll Cardiol
Comparing methods of measurement: why plotting difference against standard method is misleading
Lancet
Impact of obesity on cardiac geometry and function in a population of adolescents: the Strong Heart Study
J Am Coll Cardiol
Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight
J Am Coll Cardiol
An overview of sarcopenic obesity
J Clin Densitom
Echocardiography in hemodialysis patients: uses and challenges
Am J Kidney Dis
Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients
Kidney Int
Differential value of left ventricular mass index and wall thickness in predicting cardiovascular prognosis: data from the PAMELA population
Am J Hypertens
The prognostic importance of left ventricular geometry in uremic cardiomyopathy
J Am Soc Nephrol
A novel method of expressing left ventricular mass relative to body size in children
Circulation
Does size matter? Clinical applications of scaling cardiac size and function for body size
Circulation
Indexation of left ventricular mass in adults with a novel approximation for fat-free mass
J Hypertens
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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.