Key result
Echocardiographic z-scores in healthy children show significant regional heterogeneity.
Why the study?
Heterogeneity in reported pediatric cardiac z-scores is high, necessitating pooled analysis to ascertain overall mean z-scores for cardiac structures and function.
Meta-Analysis (n=9,074)
This meta-analysis provides pooled mean z-scores for pediatric cardiac structures but highlights significant regional heterogeneity, suggesting that while a pooled mean may be useful, local z-scores remain necessary.
Regional heterogeneity in pediatric echo z-scores warrants local references in practice; leaves open standardization of population-specific norms.
Background The application of z-scores in normalizing the cardiac size function and structural dimension will be of immense benefit to the clinician, especially in evaluating children with cardiac anomalies. However, heterogeneity in the obtained z- score results is high, thus a subgroup analysis by region (or continent) to assist healthcare practitioners is necessary. Objectives The review aimed to ascertain the overall mean z-scores for cardiac structures and function. Methods A thorough search of several databases, EMBASE, PubMed/MEDLINE, and Google Scholar was made. Articles published between January 1999 and December 2023 were recruited, of which the last search was done in December 2023. Keywords used in the search were “z-scores”, Children; echocardiography; cardiac structures; cardiac function; and body surface area (BSA)”. We restricted our search to children. Besides, additional relevant articles were manually searched. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to highlight selected studies using a pre-defined search protocol. The I 2 statistics were used to ascertain statistical heterogeneity. Results Two hundred and forty citations were identified in our search strategy, of which a total of 34 studies were identified. Twenty-four were excluded from the thirty-four studies. A total of 11 studies met our inclusion criteria shown in the PRISMA. Apart from different z scores reading obtained from various countries and regions, some authors focused on few cardiac parameters while others were exhaustive. The mean z-scores of the cardiac structures from various countries/regions range as follows; The range of Z scores obtained by different studies and regions above are as follows; MV;-1.62-0.7 AV: -1.8 -0.5 TV: -2.71 -0.7; PV ; -1.52- (-0.99) MPA; -1-81 -0.8 LPA;-1.07-0.4; RPA;-0.92- 0.1 IVSD; -0.1.77–1.89 LVPWD; -0.12-1.5 LVPWS; -0.1-0.15 LVPWS; 0.03–0.18 LVIDD; -1.13- (-0.98) LVIDS; -0.84-10.3 respectively. The mean z-score from the pooled studies showed mitral valve diameter as -0.24 ± 0.9 and pulmonary valve annuls as -1.10 ± 0.3. The left ventricular end diastolic diameter is -0.93 ± 0.3 while the left ventricular end systolic diameter is -0.05 ± 0.5. The total pooled sample size of the eleven included studies was 9074 and the mean at 95% interval was 824.9 ± 537.344. The pooled mean is presented under the model of the Mean raw (MRAW) column. The heterogeneity discovered among the selected studies was statistically significant. Conclusion Due to heterogeneity involved in the reportage of the z-scores of cardiac structures and function, it may be necessary for every region to use their z-scores domiciled in their locale. However, having a pooled mean z-score of cardiac structures and function may be useful in the near future.
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Chinawa et al. (2024) conducted a meta-analysis in Healthy children with normal cardiac structure and function (n=9,074). Echocardiographic z-score measurement was evaluated on Pooled mean z-scores of cardiac structures and function. A meta-analysis of 9,074 healthy children found significant heterogeneity in echocardiographic z-scores across regions, yielding pooled mean z-scores such as -0.24 for mitral valve diameter and -1.10 for pulmonary valve annulus.
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