Left ventricular mass normalization for body size in children based on an allometrically adjusted ratio is as accurate as normalization based on the centile curves method.

Hubert Krysztofiak,Łukasz A Małek,Wojciech Braksator,Andrzej Folga,Marcel Młyńczak,Alejandro Diaz

doi:10.1371/journal.pone.0225287

Abstract

Normalization for body size is required for reliable left ventricular mass (LVM) evaluation, especially in children due to the large variability of body size. In clinical practice, the allometrically adjusted ratio of LVM to height raised to the power of 2.7 is often used. However, studies presenting normative LVM data for children recommend centile curves as optimal for the development of normative data. This study aimed to assess whether the allometrically adjusted LVM-to-height ratio can reliably reproduce the results of LVM normalization for height based on the centile curves method. Left ventricular mass was computed for 464 boys and 327 girls, 5-18 years old, based on echocardiographic examination. Normalized data representing LVM for height were developed using the centile curves construction method and two variants of the allometrically adjusted ratio method: one variant with the allometric exponents specific to the study groups, and one variant with the universal exponent of 2.7. The agreement between the allometric methods and the centile curves method was analyzed using the concordance correlation coefficient, sensitivity, and specificity. For both the specific allometric variant and the universal variant, the analysis of concordance has indicated high reproducibility compared to the centile curves method. The respective coefficient values were 0.9917 and 0.9916 for girls, and 0.9886 and 0.9869 for boys. The sensitivity and specificity test has also shown high agreement. However, for girls, the sensitivity was higher for the specific variant (100% vs. 90.9%). The results of the study show that allometric scaling of LVM for height can very reliably reproduce the results of LVM normalization for height based on the centile curves method. However, the analysis of sensitivity and specificity indicates greater agreement for the allometric normalization with the group-specific allometric exponents.

Highlights

Echocardiographic linear heart dimensions and left ventricular mass (LVM), which is calculated based on the linear dimensions of the left ventricle [1,2], are examined in daily clinical practice
We showed that among the frequently used body size variables, i.e., body surface area (BSA), lean body mass calculated based on predictive equations, and height, only height provides reliable normalization of LVM [11]
A question arises: what body size variable is the best for LVM normalization? In our recent study, we indicated that among commonly used scaling variables, like BSA, LBM computed based on the predictive equation, and height, only height allows for reliable evaluation of LVM in child and adolescents athletes [11]

Summary

Introduction

Echocardiographic linear heart dimensions and left ventricular mass (LVM), which is calculated based on the linear dimensions of the left ventricle [1,2], are examined in daily clinical practice. The calculation of LVM allows confirmation of the presence of left ventricular hypertrophy (LVH) [2], which is a concern in cardiovascular diseases and a predictor of poor outcome [3,4]. It is a concern in athletes in whom regular exercise causes physiological changes to the heart, including hypertrophy [5,6,7]. Normalization for body size is required for reliable left ventricular mass (LVM) evaluation, especially in children due to the large variability of body size. This study aimed to assess whether the allometrically adjusted LVM-to-height ratio can reliably reproduce the results of LVM normalization for height based on the centile curves method

Objectives

Methods

Conclusion