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156 A new tool to aid the differential diagnosis of physiological remodelling from cardiac pathology when assessing left ventricle and left atrial structure in male arab and black paedaitric athletes
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  1. Gavin McClean
  1. Royal Cornwall Hospital Trust, Truro, UK

Abstract

Background Physiological remodelling of the paediatric athletes’ heart can overlap with phenotypic expression of cardiomyopathies, which increase the risk of sudden cardiac death. This overlap may be compounded by BSA, race, chronological and biological age. We established nomograms and Z-scores for clinical evaluation of left ventricular (LV) and atrial (LA) structure in Arab and black paediatric athletes, accounting for the impact of BSA, race, chronological and biological age.

Methods 417 (297 Arab, 120 black) male paediatric (11-18 years) athletes, were evaluated by 2D echocardiography as per the as per British Society of Echocardiography guidelines, and biological age (by radiological X-ray) assessment. Z scores involved allometric (a*[BSA]^((b+c*chronological age) )) modelling for measures of LV structure.

Results Residual linear regression, revealed normalised measures of LV to be independent of BSA, race, chronological and biological age. Z-scores for an athlete with a specific BSA and/or chronological age can be calculated 1) visually in the nomograms provided (figure 1) 2) automatically online/on the EchoCalc app (Figure 2), or 3) manually from by using the specified a, b, and c mean predicted parameters and d, e, and f RSD for that parameter of LV structure from table 1: z=(obs-(a*[BSA]^((b+c*chronological age) )) )/(d+(e*BSA)+(f*chronological age))

Abstract 156 Figure 1

Scatter plots of: A, Left Ventricle Internal Diameter (LVIDd); B, LV Mass to BSA in 297 Arab (white dots) and 120 black athletes (black dots), with predicted Z boundaries. Solid blue line, Z=0; dashed blue line, Z=1 and -1; solid red line, Z=2 and -2

Abstract 156 Figure 2

Home page and pages for data entry of patient demographics and measured parameters allowing for automated calculation of Z-score online and on the EchoCalc app for use on android/iPhone. The data can be stored as a “.pdr document for emailing or storage on most browsers

Abstract 156 Table 1

Models, Predicted Mean and Regressed Standard Deviation Parameters for Measurements of Left Ventricle, Atrial and Aortic Root Size in the Male Arab and Black Paediatric Athlete

Conclusion For the first time, we present BSA, race, chronological, and biological age independent nomograms and Z scores for LV, LA and Aortic size to BSA in male Arab and black paediatric athletes. Nomograms are provided to assist in the tracking of the paediatric athlete necessitating annual follow-up and online/app calculation to facilitate use in day-to-day practice (figures 1 and 2). In clinical context, we propose a new tool for differential diagnosis of physiological remodelling to an indicator of cardiac pathology in the cardiac screening of the paediatric athlete.

Conflict of Interest None

  • Paediatric Athlete’s Heart
  • New Z Scores
  • Left Ventricle

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