Subjects were excluded if body weight was 2500g or less, which is considered as low birth weight (WHO), and if left ventricular fractional shortening (FS), which is described below, was lower than 25%, which defines insufficient shortening of the left ventricle. Taking into account the accepted standard for normal values expressed as average value±2 standard deviations, the LV EF in our study was 61.2±8.9%. This supports the validity of the RV volumetric method used. The echo variables tested were left atrial size, left ventricular wall thickness, and fractional shortening. To date, more precise measurement of cardiac dimensions is available because echocardiographic technology has evolved. This term is valid for a Gaussian probability density function with equal variance in the various body weight categories. Minor deviations from ideal shape can be explained by a relatively small number of persons in study and inherent inaccuracy of measurements. 3–5 A reason, which could explain the absence of gender difference found in our study, might be that any small gender difference would be hidden within the range of interobserver variability. To test for differences in scatter between boys and girls and between several categories of body weight, the standard deviations of the residuals were compared. For this reason, a comparison was made between data of the two study groups, before considering a merging of the data. RV volumetry was based on ellipsoidal shell model method. IVS=Interventricular septum, LVPW=left ventricle posterior wall, LVID (ED)=left ventricle inner dimension at end diastole, LVID (ES)=left ventricle posterior wall at end systole.
All volumes were indexed per m 2 of BSA and the rate distribution of measured and calculated values were evaluated. Aim To renew the echocardiographic reference values of heart dimensions in healthy children. Similar to our results, all studies comparing RV and LV volumetry by whichever method, found higher estimates for RV systolic and diastolic volumes than those of the LV. The percentages of cardiac dimensions under the current P5 and P50 and above the current P95 are presented separately for boys and girls.
So, if boys would have larger LV-dimensions, it should be expected that the walls are thicker as well, which was not observed in the present study. All volumes were indexed per m 2 of BSA. Though MRI is considered the gold standard in RV volumetry, 1–3 the selection of preferred method is influenced also by its availability, cost, patient's comfort and repeatability during follow-up, therefore echocardiography might be preferred. Gender used to be a significant determinant for all cardiac dimensions in Dutch children. Twelve cardiologists and technicians performed the cardiac examinations of study group 1. From this full model a simple model was derived. There was no correlation between EF and patient's age. The data were then plotted versus the natural logarithm of body weight together with the current reference percentiles. This was done with Levene's test for homogeneity of variances. All included children were diagnosed as normal, or as having innocent heart murmur. The latter is not observed in our data (cf., Figs. Reference ranges were established in the early eighties by measuring cardiac dimensions of healthy Dutch children and adults by M-mode echocardiography. Their respective RV volumes and EF were calculated as mentioned above. Study group 1 consisted of 587 infants and children (361 boys and 226 girls) who were retrospectively analyzed. Efficacy and safety of sclerotherapy with polidocanol in children with internal hemorrhoids. However, it may be seen that LVPW data of study group 1 are generally smaller than the P50 , whereas LVID (ED) are showing a lower regression slope. Distribution of values of indexed ventricular volumes and EF in our study approached Gaussian curve, which is typical for biological measurements. All measurements were performed on SONOS 5500 (Agilent Technologies, Inc., Andover, Massachussetts) using S3 probe in harmonic imaging mode. Distribution rate of indexed SVI of RV and LV in healthy population. Only indirect validation of the ellipsoidal shell model using SV determination by thermodilution has been accomplished. Intercept, slope and standard deviation of residuals (sd) of regression equation after logarithmic transformation of data for current reference ranges of interventricular septum (IVS), left ventricle posterior wall (LVPW), left ventricle inner dimension (LVID) at end diastole (ED) and at end systole (ES) for boys and girls 12. No correlation with patient's age was observed. Evaluation of the RV function based on quantitative volumetry is superior to semiquantitative methods, however it requires solid methodology: exact projections and accuracy in measurements. Again, no conclusions can be drawn because the number of observers of the previous study of reference ranges of Dutch children 1 is not known. The lowest value in our study group was 40%, the average value±2 δ being 53.9±14.2. Except for IVS, if body weight and age are analyzed simultaneously, both determinants turn out to be significant. In our study the average age of males was lower than that of females, but not significantly. The P50 of a particular body weight can be calculated by the following formula: P50 =e intercept ×(body weight) slope . Afterload is another potential factor influencing RV EF. End diastolic (ED) LV inner dimension is defined at the beginning of the Q-wave on the ECG. To assume as the lower range of RV EF we suggest 40% for males and 45% for females.
Thijssen, O. Daniels, New reference values for echocardiographic dimensions of healthy Dutch children, European Journal of Echocardiography, Volume 7, Issue 2, March 2006, Pages 113–121, https://doi.org/10.1016/j.euje.2005.03.012. RV and LV EF of the persons in our study were not dependent on the age ( Fig. The normal range of individual parameters was expressed as mean value±2 standard deviations ( δ ). To interpret quantitative echocardiographic data, cardiac dimensions have to be compared with normal values.
This phenomenon will have a consequence for the slope of the linear regression line of the new data.
Indexed volumes and EF of RV and LV in healthy population (mean value±2 standard deviations). All measurements were performed in both systole and diastole. Abstract. There are two major challenges: firstly, selection of the appropriate method and secondly, the interpretation of the results. Your comment will be reviewed and published at the journal's discretion. Values were related exclusively to body weight. If gender would be an important determinant, it would have been significant for all cardiac dimensions, since the expectation has to be that a larger heart needs thicker walls because of Laplace's law. It may be noted in these figures that the percentages as given in Tables 2 and 3 are different for different weight categories. Our experience as well as recent literature indicate that echocardiography is a relatively easy and reliable also in this respect. The definition of FS is as follows: (LVID (ED)−LVID (ES))/LVID (ED)×100 [%]. 1991. Percentages with 95% confidence interval of cardiac dimensions, which are under the current P5 , under the current P50 and above the current P95 for boys ( N =361), Percentages with 95% confidence interval of cardiac dimensions, which are under the current P5 , under the current P50 and above the current P95 for girls ( N =226). The best predicting model was chosen by the determinants that turned out to be significant ( p <0.05) and by the proportion of variance that could be explained by the regression ( R2 ).
The regression lines are independent of gender. No explanation for this difference is known. Left ventricular fractional shortening (FS) was calculated from the left ventricular dimensions. 13 Additional research will be necessary to identify effects of physical activity on cardiac structures at young age. Appropriate reference ranges are essential for identifying abnormalities of the heart quantitatively. The first model contained all the determinants (body weight, age, gender) and the interaction variables with gender. The main limitation is a relatively small study group. If the data of the prospective study would be included for the reference ranges, one single cardiologist would be represented abundantly, because the prospective study group consisted of 160 subjects. Subjects were included if the diagnosis was either normal heart or innocent cardiac murmur. It appeared that heart dimensions on average are smaller and the slope of regression lines is different nowadays. The correlation between the age and EF of respective RV and LV was tested by regression analysis. 18. In the prospective study group the measured thicknesses of the LVPW are smaller, but still within the range of normal values, as compared with those measured in the retrospective study group. A normal LVEF reading for adults over 20 years of age is 53 to 73 percent.An LVEF of below 53 percent for women and 52 percent for men is considered low.
In daily echocardiographical practice there is a need for exact quantification of right ventricular (RV) volumes (tricuspid and pulmonary regurgitation, interatrial shunts) as well as exact assessment of right ventricular ejection fraction (EF) (pulmonary hypertension, ischemic heart disease, cardiomyopathies). Normal mean value of RV EF is 53.9%. The echocardiographic measures were taken from M-mode recordings, selected in left ventricle parasternal long axis view B-mode images, and measured according to the “leading-edge” method.
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