Reference intervals for the echocardiographic measurements of the right heart in children and adolescents: a systematic review.
BACKGROUND
Transthoracic echocardiography is the primary imaging modality for the diagnosis of right ventricular (RV) involvement in congenital and acquired heart diseases. There is increasing recognition of the contribution of RV dysfunction in heart diseases affecting children and adolescents, but there is insufficient information on reference intervals for the echocardiographic measurements of the right heart in children and adolescents that represent all the continental populations of the world.


OBJECTIVE
The aim of this systematic review was to collate, from published studies, normative data for echocardiographic evaluation of the right heart in children and adolescents, and to identify gaps in knowledge in this field especially with respect to sub-Saharan Africans.


METHODS
We performed a systematic literature search to identify studies of reference intervals for right heart measurements as determined by transthoracic echocardiography in healthy children and adolescents of school-going age. Articles were retrieved from electronic databases with a combination of search terms from the earliest date available until May 2013.


RESULTS
Reference data were available for a broad range of variables. Fifty one studies out of 3096 publications were included. The sample sizes of the reference populations ranged from 13 to 2036 with ages varying from 5 to 21 years. We identified areas lacking sufficient reference data. These included reference data for determining right atrial size, tricuspid valve area, RV dimensions and areas, the RV % fractional area change, pulmonary artery pressure gradients and the right-sided haemodynamics, including the inferior vena cava dimensions and collapsibility. There were no data for sub-Saharan African children and adolescents.


CONCLUSIONS
Reliable reference data are lacking for important echocardiographic measurements of the RV in children and adolescents, especially for sub-Saharan Africans.
Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, Cape Town, South Africa. caroliseclintech@yahoo.com.
Carolina E
CE
Lemmer Hunsinger
Mark E
ME
Engel
John C
JC
Stanfliet
Bongani M
BM
Mayosi
D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D055815:Young Adult