Limitations of Expressing Left Ventricular Mass Relative to Height and to Body Surface Area in Children

Background: Left ventricular (LV) mass varies in proportion to lean body mass (LBM) but is usually expressed relative to height or body surface area (BSA), each of which functions as a surrogate for LBM. The aims of this study were to characterize the adiposity-related biases associated with each of these scaling variables and to determine the impact of these biases on the diagnosis of LV hypertrophy (LVH) in a group of children at risk for LVH. Methods: In a retrospective study, LV mass was estimated using M-mode echocardiography in 222 healthy nonoverweight reference children and 112 children "at risk" for LVH (48 healthy overweight children and 64 children with hypertension). LBM was estimated for all children using validated predictive equations and was considered the criterion scaling variable. Z scores for LV mass for LBM, LV mass for height, and LV mass for BSA were calculated for each child relative to the reference group. The performance of height-based and BSA-based Z scores were compared with that of LBM-based Z scores at different levels of adiposity (estimated by the Z score for body mass index for age [BMIz]). Results: Among healthy normotensive children, LV mass-for-height Z scores were greater than LV mass-for-LBM Z scores at higher values of BMIz and lower than LV mass-for-LBM Z scores at lower values of BMIz (R-2 = 0.52, P < .0001). LV mass-for-BSA Z scores for agreed well with LBM-based Z scores at BMIz < 0.7 but were lower than LV mass-for-LBM Z scores for at BMIz > 0.7 (R-2 = 0.31, P < .0001). Compared with 13% of at-risk children classified as having LVH on the basis of LV mass for LBM > 95th percentile, 30% and 11% had LVH when LV mass was scaled to height and BSA, respectively. Conclusions: Scaling LV mass to BSA in children results in less misclassification with respect to LVH than does scaling to height. (J Am Soc Echocardiogr 2013;26:410-8.)