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Height Versus Body Surface Area to Normalize Cardiovascular Measurements in Children Using the Pediatric Heart Network Echocardiographic Z-Score Database.

ABSTRACT: Normalizing cardiovascular measurements for body size allows for comparison among children of different ages and for distinguishing pathologic changes from normal physiologic growth. Because of growing interest to use height for normalization, the aim of this study was to develop height-based normalization models and compare them to body surface area (BSA)-based normalization for aortic and left ventricular (LV) measurements. The study population consisted of healthy, non-obese children between 2 and 18 years of age enrolled in the Pediatric Heart Network Echo Z-Score Project. The echocardiographic study parameters included proximal aortic diameters at 3 locations, LV end-diastolic volume, and LV mass. Using the statistical methodology described in the original project, Z-scores based on height and BSA were determined for the study parameters and tested for any clinically significant relationships with age, sex, race, ethnicity, and body mass index (BMI). Normalization models based on height versus BSA were compared among underweight, normal weight, and overweight (but not obese) children in the study population. Z-scores based on height and BSA were calculated for the 5 study parameters and revealed no clinically significant relationships with age, sex, race, and ethnicity. Normalization based on height resulted in lower Z-scores in the underweight group compared to the overweight group, whereas normalization based on BSA resulted in higher Z-scores in the underweight group compared to the overweight group. In other words, increasing BMI had an opposite effect on height-based Z-scores compared to BSA-based Z-scores. Allometric normalization based on height and BSA for aortic and LV sizes is feasible. However, height-based normalization results in higher cardiovascular Z-scores in heavier children, and BSA-based normalization results in higher cardiovascular Z-scores in lighter children. Further studies are needed to assess the performance of these approaches in obese children with or without cardiac disease.

SUBMITTER: Mahgerefteh J

PROVIDER: S-EPMC8684290 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The relationship between ewe body condition score (BCS) and liveweight (LW) has been exploited previously to predict the former from LW, LW-change, and previous BCS records. It was hypothesized that if fleece weight and conceptus-free liveweight and LW-change, and in addition, height at withers were used, the accuracy of current approaches to predicting BCS would be enhanced. Ewes born in 2017 (n = 429) were followed from 8 mo to approximately 42 mo of age in New Zealand. Individual ewe data were collected on LW and BCS at different stages of the annual production cycle (i.e., prebreeding, at pregnancy diagnosis, prelambing, and weaning). Additionally, individual lambing dates, ewe fleece weight, and height at withers data were collected. Linear regression models were fitted to predict current BCS at each ewe age and stage of the annual production cycle using two LW-based models, namely, unadjusted for conceptus weight and fleece weight (LW alone1) and adjusted (LW alone2) models. Furthermore, another two models based on a combination of LW, LW-change, previous BCS, and height at withers (combined models), namely, unadjusted (combined1) and adjusted for conceptus and fleece weight (combined2), were fitted. Combined models gave more accurate (with lower root mean square error: RMSE) BCS predictions than models based on LW records alone. However, applying adjusted models did not improve BCS prediction accuracy (or reduce RMSE) or improve model goodness of fit (R 2) (P > 0.05). Furthermore, in all models, both LW-alone and combined models, a great proportion of variability in BCS, could not be accounted for (0.25 ≥ R 2 ≥ 0.83) and there was substantial prediction error (0.33 BCS ≥ RMSE ≥ 0.49 BCS) across age groups and stages of the annual production cycle and over time (years). Therefore, using additional ewe data which allowed for the correction of LW for fleece and conceptus weight and using height at withers as an additional predictor did not improve model accuracy. In fact, the findings suggest that adjusting LW data for conceptus and fleece weight offer no additional value to the BCS prediction models based on LW. Therefore, additional research to identify alternative methodologies to account for individual animal variability is still needed.

Project description:ObjectivesCurrent diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up.MethodsFinite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models.ResultsOf 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter < 5.5 cm. Peak wall stresses did not significantly differ across guideline thresholds for diameter/BSA (circumferential: p = 0.15; longitudinal: p = 0.18), but did differ for diameter/height (circumferential: p = 0.003; longitudinal: p = 0.048). All-cause mortality was independently associated with peak longitudinal stresses (p = 0.04). Peak longitudinal stresses were best predicted by diameter (c-statistic = 0.66), followed by diameter/height (c-statistic = 0.59), and diameter/BSA (c-statistic = 0.55).ConclusionsDiameter/height improved stratification of peak wall stresses compared to diameter/BSA. Peak longitudinal stresses predicted all-cause mortality independent of age and indexed diameter and may aid risk stratification for aTAA adverse events.

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Height Versus Body Surface Area to Normalize Cardiovascular Measurements in Children Using the Pediatric Heart Network Echocardiographic Z-Score Database.

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