A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study - The Z-score.
BACKGROUND
Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries.


OBJECTIVE
This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each.


METHODS
The study was conducted at two centers in India - Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system.


RESULTS
For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived.


CONCLUSIONS
The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.
Department of Cardiology, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India.
Rajendra Kumar
RK
Gokhroo
Department of Cardiology, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India.
Avinash
A
Anantharaj
Department of Cardiology, Ace Heart and Vascular Institute, Shivalik Hospital Premises, Sector 69, Mohali, Punjab, India.
Devendra
D
Bisht
Department of Cardiology, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India.
Kamal
K
Kishor
Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Nishad
N
Plakkal
Department of Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Rajeswari
R
Aghoram
Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Nivedita
N
Mondal
Department of Cardiology, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India.
Shashi K
SK
Pandey
Department of Cardiology, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India.
Ramsagar
R
Roy
Developing country; Z-score; echocardiography; pediatric