Department of Pediatric Cardiology , University Medical Center Utrecht, Utrecht, The Netherlands.
J Am Soc Echocardiogr. 2013 Nov;26(11):1314-21. doi: 10.1016/j.echo.2013.07.022. Epub 2013 Aug 22.
Hypoplastic left heart complex (HLHC) is characterized by a mitral valve or an aortic valve annular Z score < -2, antegrade flow in the ascending aorta, ductal dependency, coarctation or aortic arch hypoplasia, and absence of significant (sub)valvar stenosis. The Z scores of the mitral and aortic valve annuli are major determinants of HLHC. Therefore, the algorithm for Z-score calculation is essential for diagnosis. However, no single universal method of calculation is in use. In the scientific literature addressing HLHC, various Z-score calculation methods have been applied. The aim of this study was to evaluate Z scores derived from two-dimensional echocardiographic dimensions in patients with HLHC.
To compare the different published methods using two-dimensional echocardiographic measures for Z-score calculation, a cohort of 18 newborns diagnosed with HLHC was retrospectively evaluated. In addition, the methods to determine body surface area in newborns were evaluated.
Three Z-score calculation methods were included and compared. Using the method of Daubeney et al. to calculate Z scores in our cohort illustrated a lack of correlation beyond a Z score < 0, compared with the methods of Zilberman et al. and Pettersen et al. Z scores calculated using Zilberman et al.'s and Pettersen et al.'s methods were fairly consistent. The equations used by Pettersen et al. are based on the largest population of neonates.
Although the different methods for calculating Z scores for mitral and aortic valve dimensions correspond fairly well in the normal range, Z scores < -2 diverge substantially. A useful scientific comparison of published data and outcomes of patients with HLHC remains elusive. The Z-score calculation algorithms used by Pettersen et al. appear to be the most appropriate for use in an evaluation of HLHC. Because these different methods can yield different values, reporting the method as well as the Z score is essential for an accurate diagnosis. Similarly, the method used to determine body surface area should be reported.
左心发育不良综合征（HLHC）的特征为二尖瓣或主动脉瓣环 Z 评分<-2、升主动脉前向血流、依赖导管、缩窄或主动脉弓发育不良，以及不存在明显（亚）瓣狭窄。二尖瓣和主动脉瓣环的 Z 评分是 HLHC 的主要决定因素。因此，Z 评分计算算法对于诊断至关重要。然而，目前尚无单一通用的计算方法。在涉及 HLHC 的科学文献中，已经应用了各种 Z 评分计算方法。本研究旨在评估 HLHC 患者二维超声心动图测量值得出的 Z 评分。
为了使用二维超声心动图测量值比较不同的已发表 Z 评分计算方法，我们回顾性评估了 18 例被诊断为 HLHC 的新生儿。此外，还评估了确定新生儿体表面积的方法。
纳入并比较了三种 Z 评分计算方法。使用 Daubeney 等人的方法在我们的队列中计算 Z 评分，与 Zilberman 等人和 Pettersen 等人的方法相比，在 Z 评分<-0 时相关性较差。使用 Zilberman 等人和 Pettersen 等人的方法计算的 Z 评分相当一致。Pettersen 等人使用的方程基于最大的新生儿人群。
尽管用于计算二尖瓣和主动脉瓣尺寸的不同方法在正常范围内相当一致，但 Z 评分<-2 时差异较大。对于 HLHC 患者的发表数据和结果进行有用的科学比较仍然难以实现。Pettersen 等人使用的 Z 评分计算算法似乎最适合用于 HLHC 的评估。由于这些不同的方法可能会产生不同的数值，因此报告方法和 Z 评分对于准确诊断至关重要。同样，应该报告确定体表面积的方法。
