Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
Por:
Freixa-Benavente, A, Juzga-Corrales, C, Ayerza-Casas, A, Figueras-Coll, M, Escribà-Bori, S, Plata-Izquierdo, B, Collell, R, González-Marín, MA, Siurana, JM, Sorlí-García, M, de la Torre, L, Teodoro-Marín, S, Rodriguez, M, Domínguez-García, O, Rellán, S, Manso, B, López-Abel, B, Alvarez-Pérez, R, Portillo-Márquez, M, Rezola-Arcelus, E, Centeno-Malfaz, F, Solana-Gracia, R, Rojo-Sombrero, H, Cantero-Tejedor, MT, Riaño, B, Tejero-Hernández, MA, Jiménez-Casso, M, Sabaté-Rotés, A
Publicada:
1 abr 2026
Ahead of Print:
1 abr 2026
Resumen:
Background: Ascending aorta (AscAo) dilatation assessment and definition in pediatric bicuspid aortic valve (BAV) is challenging. We compared the Pediatric Heart Network (PHN) nomogram against the Halifax (HZ) one and analyzed their association with body surface area indexing (BSAI). Methods: Echocardiographies from a national BAV registry were analyzed. AscAo and sinus of Valsalva, standardized using nomograms and BSAI, were compared by correlation and Bland-Altman tests. Nomogram +2 and + 3 z-scores thresholds contrasted against >21 mm/BSA-m2 by logistic regression and kappa agreement index. Age subgroup analysis was between adult-size (>= 10 years and BSA >= 1.5 m(2)) and small children. Results: A total 3858 reports were analyzed. The PHN nomogram resulted in higher AscAo z-scores (median 1.516 versus 1.413). Nomogram correlation was Rho(Spearman) = 0.979 and Bland-Altman agreement bias was 0.302, with higher divergence in extreme z-scores. Patients >= 10 years and BSA >= 1.5 m(2) showed better concordance (bias -0.212 versus 0.440) despite similar correlation to the younger group. There was moderate but significant correlation amongst AscAo BSA-indexed diameters and PHN (Rho(Spearman) = 0.514, p < 0.001) and HZ nomograms (Rho(Spearman) = 0.366, p < 0.001), being higher in the older cohort than the younger, both by PHN (Rho(Spearmam) 0.961 versus 0.424) and HZ (Rho(Spearman) 0.952 versus 0.540). Higher area under the curve was obtained by PHN. A lower percentage was classified as dilated with PHN than by BSA-I in the adult-size cohort, but not in younger patients. Discussion: There was good correlation and concordance between HZ and PHN nomograms, the latter resulting in higher z-scores. PHN has better agreement with BSA-I than HZ, with the PHN > +3 z-score threshold being the highest predictor for BSA-I dilatation definition, also showing higher specificity and sensitivity. BSA-I classified fewer patients as dilated than nomograms in adult-sized children but not in the younger cohort. Clinicians should be aware of this effect of BSA when normalizing diameters. (c) 2025 Japanese College of Cardiology. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Filiaciones:
Freixa-Benavente, A:
Univ Autonoma Barcelona, Dept Pediat Obstet & Gynecol & Prevent Med & Publ, Bellaterra, Spain
Vall Hebron Univ Hosp, Pediat Cardiol Serv, Barcelona, Spain
Royal Brompton Hosp, Pediat Cardiol Serv, London, England
Autonoma Barcelona Univ, Barcelona, Spain
Vall Hebron Univ Hosp, Children & Maternal Hosp, Passeig Vall Hebron 119-129, Barcelona 08035, Spain
Royal Brompton Hosp, Sydney St, London SW6 3NP, England
Juzga-Corrales, C:
Vall Hebron Univ Hosp, Pediat Cardiol Serv, Barcelona, Spain
Ayerza-Casas, A:
Miguel Servet Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Zaragoza, Spain
Figueras-Coll, M:
Univ Autonoma Barcelona, Dept Pediat Obstet & Gynecol & Prevent Med & Publ, Bellaterra, Spain
Josep Trueta Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Girona, Spain
Escribà-Bori, S:
Son Espases Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Palma De Mallorca, Spain
Plata-Izquierdo, B:
Univ Complejo Asistencial Salamanca, Pediat Serv, Pediat Cardiol Unit, Salamanca, Spain
Collell, R:
St Joan Reus Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Reus, Spain
González-Marín, MA:
Univ Gen Hosp, Pediat Serv, Pediat Cardiol Unit, Ciudad Real, Spain
Siurana, JM:
Hosp HM Nens, Hlth Invest Inst HM Hosp, HM Hosp, Pediat Cardiol & Cardiol Serv, Barcelona, Spain
Sorlí-García, M:
Gen Univ Hosp Santa Lucia, Pediat Serv, Pediat Cardiol Unit, Cartagena, Spain
de la Torre, L:
12 Octubre Univ Hosp, Pediat Inst Heart, Madrid, Spain
Teodoro-Marín, S:
Univ Hosp Parc Tauli, Pediat Serv, Pediat Cardiol Unit, Sabadell, Spain
Rodriguez, M:
HM Monteprincipe Hosp, Congenital Cardiol & Cardiac Surg Serv, Madrid, Spain
Domínguez-García, O:
Virgen Salud Hosp, Pediat Serv, Pediat Cardiol Unit, Toledo, Spain
Rellán, S:
Valladolid Clin Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Valladolid, Spain
Manso, B:
Virgen Rocio Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Sevilla, Spain
López-Abel, B:
Univ Hosp Santiago Compostela, Pediat Serv, Pediat Cardiol Unit, Santiago de Compostela, Spain
Alvarez-Pérez, R:
Santa Creu i St Pau Hosp, Pediat Serv, Pediat Cardiol Unit, Barcelona, Spain
Portillo-Márquez, M:
Merida Hosp, Pediat Serv, Pediat Cardiol Unit, Badajoz, Spain
Rezola-Arcelus, E:
Donostia Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Donostia, Spain
Centeno-Malfaz, F:
Rio Ortega Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Valladolid, Spain
Solana-Gracia, R:
Infanta Leonor Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Madrid, Spain
Rojo-Sombrero, H:
Principe Asturias Univ Hosp, Pediat Serv, Pediat Cardiol Unit, Alcala De Henares, Spain
Cantero-Tejedor, MT:
Complejo Asistencial Palencia, Pediat Serv, Pediat Cardiol Unit, Palencia, Spain
Riaño, B:
San Pedro Hosp, Cardiol Serv, Pediat Cardiol Unit, Logrono, Spain
Tejero-Hernández, MA:
Reg Univ Hosp Reina Sofia, Clin Management Unit, Cordoba, Spain
Jiménez-Casso, M:
Gen Hosp Segovia, Pediat Serv, Pediat Cardiol Unit, Segovia, Spain
Sabaté-Rotés, A:
Univ Autonoma Barcelona, Dept Pediat Obstet & Gynecol & Prevent Med & Publ, Bellaterra, Spain
Vall Hebron Univ Hosp, Pediat Cardiol Serv, Barcelona, Spain
Gen Hosp Segovia, Pediat Serv, Pediat Cardiol Unit, Segovia, Spain
Green Submitted, hybrid
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