Several articles have proposed reference values in healthy paediatric subjects, but none of them has evaluated a large population of healthy trained adolescents.
Design
The study purpose was to establish normal echocardiographic measurements of left heart (aortic root, left atrium and left ventricular dimensions and mass) in relation to age, weight, height, body mass index, body surface area and training hours in this specific population.
Methods
We retrospectively evaluated 2151 consecutive, healthy, peri-pubertal athletes (100% male, mean age 12.4 ± 1.4 years, range 8–18) referred to a single centre for pre-participation screening. All participants were young soccer athletes who trained for a mean of 7.2 ± 1.1 h per week.
Results
Left ventricular internal diameters, wall thickness, left ventricular mass, aortic root and left atrium diameters were significantly correlated to age, body surface area, height and weight (p < 0.01). Age, height, weight and body surface area were found associated with chamber size, while body mass index and training hours were not. Inclusion of both age and body size parameters in the statistical models resulted in improved overall explained variance for diameters and left ventricular mass.
Conclusion
Equations, mean values and percentile charts for the different age groups may be useful as reference data in efficiently assessing left ventricular parameters in young athletes.
SharmaSMaronBJWhyteGet al.Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol2002; 40: 1431–1436.
2.
Sharma S, Drezner JA, Baggish A, et al. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J 2018; 39: 1466–1480.
3.
MiglioreFZorziAMichieliPet al.Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Circulation2012; 125: 529–538.
4.
CantinottiMScaleseMMolinaroSet al.Limitations of current echocardiographic nomograms for left ventricular, valvular, and arterial dimensions in children: a critical review. J Am Soc Echocardiogr2012; 25: 142–152.
5.
MawadWDroletCDahdahNet al.A review and critique of the statistical methods used to generate reference values in pediatric echocardiography. J Am Soc Echocardiogr2013; 26: 29–37.
6.
DallaireFSlorachCHuiWet al.Reference values for pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging2015; 8: e002167–e002167.
7.
RizzoMSpataroACecchetelliCet al.Structural cardiac disease diagnosed by echocardiography in asymptomatic young male soccer players: Implications for pre-participation screening. Br J Sports Med2012; 46: 371–373.
8.
CalòLSperandiiFMartinoAet al.Echocardiographic findings in 2261 peri-pubertal athletes with or without inverted T waves at electrocardiogram. Heart2015; 101: 193–200.
9.
DallaireFBigrasJLPrsaMet al.Bias related to body mass index in pediatric echocardiographic Z scores. Pediatr Cardiol2015; 36: 667–676.
10.
World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA2013; 310: 2191–2194.
11.
LopezLColanSDFrommeltPCet al.Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr2010; 23: 465–495.
12.
De SimoneGKimballTRRomanMJet al.Relation of left ventricular chamber and midwall function to age in normal children, adolescents and adults. Ital Heart J2000; 1: 295–300.
13.
HaycockGBSchwartzGJWisotskyDH. Geometric method for measuring body surface area: A height-weight formula validated in infants, children, and adults. J Pediatr1978; 93: 62–66.
14.
SluysmansTColanSD. Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol (1985)2005; 99: 445–457.
15.
KampmannCWiethoffCMWenzelAet al.Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart2000; 83: 667–672.
16.
KaldararovaMBalazovaETittelPet al.Echocardiographic measurements of the aorta in normal children and young adults. Bratisl Lek Listy2007; 108: 437–441.
17.
NeilanTGPradhanADKingMEet al.Derivation of a size-independent variable for scaling of cardiac dimensions in a normal paediatric population. Eur J Echocardiogr2009; 10: 50–55.
18.
ChubbHSimpsonJM. The use of Z-scores in paediatric cardiology. Ann Pediatr Cardiol2012; 5: 179–184.
19.
CavarrettaEPeruzziMFratiGet al.When enough is more than enough: The hidden side of the cardiac effects of intense physical exercise. Int J Cardiol2018; 258: 224–225.
20.
Sanz de la GarzaMGrazioliGBijnensBHet al.Inter-individual variability in right ventricle adaptation after an endurance race. Eur J Prev Cardiol2016; 23: 1114–1124.
21.
De CastroSPellicciaACaselliSet al.Remodelling of the left ventricle in athlete’s heart: A three dimensional echocardiographic and magnetic resonance imaging study. Heart2006; 92: 975–976.
22.
De CastroSCaselliSMaronMet al.Left ventricular remodelling index (LVRI) in various pathophysiological conditions: A real-time three-dimensional echocardiographic study. Heart2007; 93: 205–209.
23.
RowlandTWUnnithanVBMacFarlaneNGet al.Clinical manifestations of the ‘athlete’s heart’ in prepubertal male runners. Int J Sports Med1994; 15: 515–519.
24.
ZdravkovicMPerunicicJKrotinMet al.Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers. J Sci Med Sport2010; 13: 602–606.
25.
D’AscenziFPellicciaAValentiniFet al.Training-induced right ventricular remodelling in pre-adolescent endurance athletes: The athlete’s heart in children. Int J Cardiol2017; 236: 270–275.
26.
D’AscenziFSolariMAnselmiFet al.Atrial chamber remodelling in healthy pre-adolescent athletes engaged in endurance sports: A study with a longitudinal design. The CHILD study. Int J Cardiol2016; 223: 325–330.
27.
PelàGCrocamoALi CalziMet al.Sex-related differences in left ventricular structure in early adolescent non-professional athletes. Eur J Prev Cardiol2016; 23: 777–784.
28.
McCleanGRidingNRArdernCLet al.Electrical and structural adaptations of the paediatric athlete’s heart: A systematic review with meta-analysis. Br J Sports Med2018; 52: 230–230.
29.
Pelliccia A, Caselli S, Sharma S, et al. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: Recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart. Eur Heart J. Epub ahead of print 23 September 2017. DOI: 10.1093/eurheartj/ehx532.
30.
D’AscenziFCaselliSSolariMet al.Novel echocardiographic techniques for the evaluation of athletes’ heart: A focus on speckle-tracking echocardiography. Eur J Prev Cardiol2016; 23: 437–446.
31.
LotrionteMCavarrettaEAbbateAet al.Temporal changes in standard and tissue Doppler imaging echocardiographic parameters after anthracycline chemotherapy in women with breast cancer. Am J Cardiol2013; 112: 1005–1012.
32.
GautierMDetaintDFermanianCet al.Nomograms for aortic root diameters in children using two-dimensional echocardiography. Am J Cardiol2010; 105: 8888–8894.
