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(Circulation. 2008;117:2769-2775.)
© 2008 American Heart Association, Inc.

Pediatric Cardiology

A Novel Method of Expressing Left Ventricular Mass Relative to Body Size in Children

Bethany J. Foster, MD, MSCE; Andrew S. Mackie, MD, SM; Mark Mitsnefes, MD; Huma Ali; Silvia Mamber, MD; Steven D. Colan, MD

From the Department of Pediatrics, Divisions of Nephrology (B.J.F., S.M.) and Cardiology (A.S.M.), Montreal Children’s Hospital, McGill University Faculty of Medicine, Montreal, Canada; Department of Pediatrics, Division of Nephrology, Cincinnati Children’s Hospital Medical Center (M.M.), Cincinnati, Ohio; McGill University Faculty of Medicine (H.A.), Montreal, Canada; and Department of Cardiology (S.D.C.), Children’s Hospital Boston, Harvard University School of Medicine, Boston, Mass.

Correspondence to Bethany J. Foster, Montreal Children’s Hospital, 2300 Tupper St, E-222, Montreal, Quebec H3H 1P3, Canada. E-mail beth.foster{at}muhc.mcgill.ca

Received September 21, 2007; accepted March 25, 2008.

Background— Left ventricular (LV) hypertrophy (LVH) in children is widely defined as a left ventricular mass index (LVMI, g/m^2.7) >95th percentile. However, LVMI increases with decreasing height in young children; thus, the 95th percentile LVMI will depend on the height distribution of the reference population. The objective of this study was to compare the performance of a novel method of expressing LV mass relative to body size (centile curves) with the LVMI method.

Methods and Results— LV mass was estimated by M-mode echocardiography in 440 healthy nonobese reference children (birth to 21 years) and 239 children at risk for LVH; the LVMI was calculated for all children. Three samples of 270 children, each with different height distributions, were drawn from the reference population. A sample-specific 95th percentile LVMI was determined for each reference sample. At-risk children were classified as having LVH or not based on each sample-specific 95th percentile. Four LV mass-for-height centile curves were constructed with the Cole lambda-mu-sigma method and data from each reference sample. At-risk children were each assigned an LV mass-for-height percentile with these curves and were reclassified as having LVH if LV mass-for-height was >95th percentile. The centile method provided a stable estimate of the proportion of at-risk children with LVH regardless of reference group, whereas proportion estimates varied significantly depending on the reference population when the LVMI method was used.

Conclusions— LV mass-for-height centile curves are superior to LVMI as a method of normalizing LV mass to body size in children.

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CLINICAL PERSPECTIVE

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Clinical Summaries
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