Ref 1
1. Ages 6-23 y/o
2. Significant LVM differences by gender –
3. For males 95th percentiles:
a. LVM/BSA = 103
b. LVM/height = 100
4. For females 95th percentiles:
a. LVM/BSA = 84
b. LVM/height = 81
Ref 2
1. Ages 6-17 y/o
2. Significant LVM differences by gender – males avg 99 g, females avg 80 g
3. Across races and genders - Indexing by LV mass /height **3 provided the best correlation with
LV mass/lean body mass compared to indexing with
a. BSA
b. Height
c. Height **2
d. Height ** 2.7
4. For entire group (all races and genders) 95th percentiles:
a. LVM/BSA = 89
b. LVM/height = 85
c. LVM/height **2 = 52
d. LVM/height **2.7 =39
e. LVM/height**3 = 34
Ref 3
1. The method of correcting LVM for body size and the criteria used to define LVH have varied
between studies
2. Because of the rise in the prevalence of obesity, indexing of LVM to weight or body surface area
may allow an increased LVM to be interpreted erroneously as normal. Height2.7 (in meters) has
been validated as an indicator of lean body mass and has been recommended for indexing LVM.
Use of height2.7 to index LVM also minimizes the effect of age, gender, and race.10,11
3. LVH by adult criteria was defined as LVMI > 51 g/m2.7 and by pediatric criteria as LVMI > 38.6
g/m2.7.
Ref 4
See graph
Ref 5
Adult values See Table
1. Women LVM/BSA < 95
2. Men LVM/BSA < 115
Ref 6
ASE Peds Quantification paper – Not much help.
Ref 7 (agrees with Ref 3)
1. 241 adults and 444 infants to young adults
2. Normalizations of left ventricular mass for height or body surface area introduce artifactual
relations of indexed ventricular mass to body size and errors in estimating the impact of
overweight. These problems are avoided and variability among normal subjects is reduced by
using left ventricular mass/height**2.7
Ref 8
1. Scaling LV mass to BSA in children results in less misclassification with respect to LVH than does
scaling to height.
2. Ours is not the first study to conclude that height based LV mass normalization results in
overestimation of the prevalence of LVH among the obese.
Ref 9
A number of controversies surround the measurement of LV mass. There are significant problems in
standardizing echocardiographic measurement of LV mass across echocardiography laboratories.
Historically, one method for overcoming this variability in adults is to index the LV mass to body size,
most commonly BSA, height in meters squared, or to the 2.7th power [10]. Dividing LV mass by height to
the power of 2.7 accounts for LV mass and scaling myocardial mass to body size. This useful application
has been adapted in children to compensate for normal growth [11]. However, this indexing method is
also limited in the pediatric population because LVMI2.7 increases with decreasing height [7]. Numerous
studies have shown that LVMI2.7 overestimates LV mass in adults [5]. Foster et al. [9] showed that
expressing LV mass relative to BSA or height has limitations in the pediatric population because LV mass
varies in proportion to lean body mass; however scaling LV mass to BSA in children appears to be better
than scaling to height.
Ref 10
The children and adolescents who have elevated BMI (overweight and obese) with NWC (normal waist
circumference) had LVM and LBM similar to normal controls with NWC despite having an elevated BMI
and elevated non-LBMI (as an estimation of adipose tissue). Additionally, similar to normal controls,
those subjects with elevated BMI and NWC had a stronger correlation between LVM and LBM than
subjects with elevated BMI with IWC (increased waist circumference).
References
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Cardiol 1995;76:699-701.
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4. Cain PA. et al. Age and gender specific normal values of left ventricular mass, volume and
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5. ASE Recommendations for Chamber Quantification: A Report from the American Society of
Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification
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6. ASE Recommendations for Quantification Methods During the Performance of a Pediatric
Echocardiogram: A Report From the Pediatric Measurements Writing Group of the American
Society of Echocardiography Pediatric and Congenital Heart Disease Council. JASE 2010;23:46595.
7. De Simone G, et al. Left Ventricular Mass and Body Size in Normotensive Children and Adults:
Assessment of Allometric Relations and Impact of Overweight. J Am Coli CardioI1992;20:1251-60
8. Foster et, al Limitations of expressing LV mass relative to height and to BSA in children. JASE
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10. Am J Cardiol. 2014 Mar 15;113(6):1054-7. doi: 10.1016/j.amjcard.2013.11.068. Epub 2013 Dec
25. Left ventricular mass in children and adolescents with elevated body mass index and normal
waist circumference. Mehta SK.