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 Table of Contents  
LETTER TO THE EDITOR
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 44

Estimation of Z-scores of cardiac structures in healthy Indian pediatric population


Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Web Publication15-Mar-2019

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, P.O. Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_48_18

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How to cite this article:
Al-Mendalawi MD. Estimation of Z-scores of cardiac structures in healthy Indian pediatric population. J Indian Acad Echocardiogr Cardiovasc Imaging 2019;3:44

How to cite this URL:
Al-Mendalawi MD. Estimation of Z-scores of cardiac structures in healthy Indian pediatric population. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2019 [cited 2019 Mar 19];3:44. Available from: http://www.jiaecho.org/text.asp?2019/3/1/44/254259

I read the interesting study by Trivedi et al.[1] published in the September–December 2018 issue of the Journal of The Indian Academy of Echocardiography and Cardiovascular Imaging. The authors constructed nomograms of Z-scores of 19 echocardiographic parameters derived from Indian children. Apart from few study limitations addressed by the authors, I presume that the following two limitations might cast additional suspicions on the study results and possibly impose bias in the decision-making process in the clinical settings.

First, the authors stated the gender distribution of the studied cohort was 59% of the children were males and the remaining 41% were females.[1] Regrettably, they did not attempt to determine the gender-specific echocardiographic Z-scores nomograms for the studied population. This point is important to be considered as gender could exert differences in certain echocardiographic dimensions.[2],[3] For instance, boys have been found to have larger heart valve dimensions at all ages. These valve dimension differences were statistically significant for three of four heart valves, even after adjustment for the differences in the body sizes. The difference might be due to higher circulating blood volume in boys compared to that in girls.[2] Hence, construction of gender-specific echocardiographic Z-scores nomograms was envisaged.

Second, it explicitly states that Indian population is a unique amalgamation of different ethnic backgrounds. The authors did not mention in the study methodology the exact ethnic groups of the studied population. This point is important to be taken into consideration since various echocardiographic parameters really differ among different ethnicities.[3],[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Trivedi B, Chokhandre M, Dhobe P, Garekar S. Estimation of Z-scores of cardiac structures in healthy Indian pediatric population. J Indian Acad Echocardiogr Cardiovasc Imaging 2018;2:147-54.  Back to cited text no. 1
  [Full text]  
2.
Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children: Gender-specific differences. Pediatr Cardiol 2005;26:356-60.  Back to cited text no. 2
    
3.
Lopez L, Colan S, Stylianou M, Granger S, Trachtenberg F, Frommelt P, et al. Relationship of echocardiographic Z scores adjusted for body surface area to age, sex, race, and ethnicity: The pediatric heart network normal echocardiogram database. Circ Cardiovasc Imaging 2017;10. pii: e006979.  Back to cited text no. 3
    
4.
Cosyns B, Lancellotti P. Normal reference values for echocardiography: A call for comparison between ethnicities. Eur Heart J Cardiovasc Imaging 2016;17:523-4.  Back to cited text no. 4
    




 

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