Rajagopal Hari, Uppu Santosh C, Weigand Justin, Lee Simon, Karnik Ruchika, Ko Helen, Bhatla Puneet, Nielsen James, Doucette John, Parness Ira, Srivastava Shubhika
Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA.
Biostatistics, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, 10029, USA.
Pediatr Cardiol. 2018 Jun;39(5):892-901. doi: 10.1007/s00246-018-1838-3. Epub 2018 Mar 9.
Right atrial (RA) size is a prognostic indicator for heart failure and cardiovascular death in adults. Data regarding use of RA area (RAA) by two-dimensional echocardiography as a surrogate for RA size and allometric modeling to define appropriate indexing of the RAA are lacking. Our objective was to validate RAA as a reliable measure of RA size and to define normal reference values by transthoracic echocardiography (TTE) in a large population of healthy children and develop Z-scores using a validated allometric model for indexing RAA independent of age, sex, and body size. Agreement between RAA and volume by 2D, 3D TTE, and MRI was assessed. RAA not volume by 2D TTE is an excellent surrogate for RA size. RAA/BSA has an inverse correlation with BSA with a residual relationship to BSA (r = - 0.54, p < 0.0001). The allometric exponent (AE) derived for the entire cohort (0.85) also fails to eliminate the residual relationship. The entire cohort divided into two groups with a BSA cut-off of 1 m to provide the best-fit allometric model (r = 0). The AE by least square regression analysis for each group is 0.95 and 0.88 for BSA < 1 m and > 1 m, respectively, and was validated against an independent sample. The mean indexed RAA ± SD for BSA ≤ 1 m and > 1 m is 9.7 ± 1.3 cm and 8.7 ± 1.3 cm, respectively, and was used to derive Z-scores. RAA by 2D TTE is superior to 2D or 3D echocardiography-derived RA volume as a measure of RA size using CMR as the reference standard. RAA when indexed to BSA, decreases as body size increases. The best-fit allometric modeling is used to create Z scores. RAA/BSA for BSA < 1 m and RAA/BSA for those with BSA > 1 m can be used to derive Z scores.
右心房（RA）大小是成人心力衰竭和心血管死亡的一个预后指标。关于二维超声心动图使用右心房面积（RAA）作为RA大小的替代指标以及使用异速生长模型来定义RAA的适当指数的数据尚缺乏。我们的目标是验证RAA作为RA大小的可靠测量指标，并通过经胸超声心动图（TTE）在大量健康儿童中确定正常参考值，并使用经过验证的异速生长模型开发独立于年龄、性别和体型的RAA指数Z分数。评估了RAA与二维、三维TTE和MRI测量的容积之间的一致性。二维TTE测量的是RAA而非容积，是RA大小的极佳替代指标。RAA/体表面积（BSA）与BSA呈负相关，与BSA存在残余关系（r = -0.54，p < 0.0001）。整个队列得出的异速生长指数（AE）（0.85）也未能消除残余关系。将整个队列分为两组，以1平方米的BSA为切点以提供最佳拟合异速生长模型（r = 0）。每组通过最小二乘回归分析得出的AE，对于BSA < 1平方米和> 1平方米的情况分别为0.95和0.88，并在独立样本中得到验证。对于BSA≤1平方米和> 1平方米，平均指数化RAA±标准差分别为9.7±1.3平方厘米和8.7±1.3平方厘米，并用于得出Z分数。以CMR作为参考标准，二维TTE测量的RAA作为RA大小的测量指标优于二维或三维超声心动图得出的RA容积。当根据BSA进行指数化时，RAA随体型增加而减小。使用最佳拟合异速生长模型创建Z分数。BSA < 1平方米时的RAA/BSA以及BSA > 1平方米者的RAA/BSA可用于得出Z分数。
