Published Online
on May 19, 2008

A more recent version of this article appeared on May 27, 2008

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Submitted on September 21, 2007
Accepted on March 25, 2008

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, and 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.

^* To whom correspondence should be addressed. E-mail: beth.foster{at}muhc.mcgill.ca.

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.

Key words: left ventricular hypertrophy • pediatrics • echocardiography • reference standards

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Clinical Summaries
Circulation 2008 117: 2719-2720. [Extract] [Full Text]

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