The Z-scores of cardiac indices among healthy children: a systematic review and meta-analysis.

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 I2 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.

Pulmonary hypertension and right ventricular function in Nigerian children with sickle cell anaemia.

BACKGROUND: Pulmonary hypertension (PH), a complication of sickle cell anaemia (SCA), results in considerable morbidity. This study aims to determine the prevalence and associations of echocardiography-suggested PH in children with SCA. METHODS: We performed a cross-sectional comparative study involving 100 systematically sampled SCA subjects 3-14 y of age in their steady state with matched haemoglobin AA phenotype controls. Clinical, laboratory and echocardiography data (including tricuspid regurgitation velocity [TRV], mean pulmonary arterial pressure [mPAP] and tricuspid annular plane systolic excursion [TAPSE]) were obtained from all patients. Statistical analyses were performed using SPSS version 22 (IBM, Armonk, NY, USA). A p-value <0.05 was considered statistically significant. RESULTS: Of the 100 SCA subjects studied, 22 (22%) had echocardiographic findings suggestive of PH compared with none in the controls. The median TAPSE was significantly lower in the PH group (2.55 cm [interquartile range {IQR} 2.2-2.8]) compared with the no PH group (2.77 cm [IQR 2.4-3.2]) (p=0.03). No significant correlation existed between mPAP and age, nor any laboratory parameters studied. The odds ratio (OR) suggested PH significantly increased with an increase in the frequency of hospitalizations for vaso-occlusive crises within a 12-month period (OR 15.15 [95% CI 1.57 to 146.35], p=0.02) and a lifetime history of blood transfusion (OR 5.44 [95% CI 1.09 to 27.24], p=0.04). CONCLUSIONS: Echocardiography-suggested PH is common in children with SCA and is associated with poorer right ventricular function, frequent vaso-occlusive crises and blood transfusions.

Elevated Mean Pulmonary Artery Pressure and Right Ventricular Dysfunction in Children with Chronic Kidney Disease.

BACKGROUND: Elevated mean pulmonary artery pressure (mPAP) and right heart failure increase mortality in patients with chronic kidney disease (CKD). OBJECTIVES: The objective of this study is to determine the prevalence of elevated mPAP in children with CKD compared with matched controls and to ascertain the relationship between elevated mPAP with right ventricular dysfunction and history of hemodialysis. MATERIALS AND METHODS: A cross-sectional comparative study of mPAP and tricuspid annular plane systolic excursion of 21 children with CKD and age- and sex-matched controls asymptomatic for cardiac disease was conducted. RESULTS: Median mPAP was 27.69 (18.3-36.1) mmHg in CKD patients compared with 14.55 (13.5-17.1) mmHg in controls (P = 0.002). Elevated mPAP was present in 42.9% of CKD group and 0% in controls (P < 0.001). The prevalence of right ventricle (RV) dysfunction in CKD was 9.5% and 0% in controls (P = 0.49). Right ventricular dysfunction was significantly more common in patients with elevated mPAP compared with those with normal mPAP (P < 0.001). Children with CKD who had a history of having been dialyzed were less likely to have elevated mPAP (P < 0.001). CONCLUSION: Elevated mPAP is significantly more common in children with CKD compared with controls. CKD population with mPAP elevation is more likely to have impaired RV function. The occurrence of elevated mPAP was more common in those who were never dialyzed.