A statistical comparison of reproducibility in current pediatric two-dimensional echocardiographic nomograms

Cantinotti M, Scalese M, Giordano R, Assanta N, Marchese P, Franchi E, Viacava C, Koestenberger M, Jani V, Kutty S.

Pediatr Res. 2020 Apr 24. doi: 10.1038/s41390-020-0900-z. [Epub ahead of print]

PMID: 32330930

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Background: The aim of this study is to compare new pediatric nomograms for clinical parameters from 2D echocardiography.

Methods: 2D pediatric echocardiographic parameters from four recent nomograms were used for statistical analysis. To assess the accuracy of the predictive models from each study, namely multivariate, linear, and nonlinear regression, mean values and 5th and 95th percentiles (μ ± 1.65σ) were calculated. A Z-score calculator was created.

Results: Mean values and 5th and 95th percentiles have been provided for a range of BSA (0.15-2.20 m2) for each nomogram assessed in this study. Moreover, plots of Z-scores over the same range of BSA have been generated to assess trends among different studies. For most measurements from the two most recent nomograms, namely Lopez et al. and Cantinotti et al., differences were within a Z-score of 0.5 (Z-score range: 0.001-1.26). Measurements from Sluysmans and Colan and Pettersen et al. were observed to diverge from Lopez et al. at the upper extremities of BSA. Differences among various nomograms emerged at lower extremes of BSA.

Conclusions: The two most recent echocardiographic nomograms were observed to have the most statistically similar ranges of normality. Significant deviations in ranges of normality were observed at extremes of BSA.

Impact: Echocardiographic nomograms for pediatric age are discordant.Comparison of current pediatric echocardiographic nomograms.A Z-score calculator was created.Clinical relevance of differences among nomograms is highlighted.