Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight.

BACKGROUND Relations between organs and body size are not linear but rather follow allometric (growth) relations characterized by their powers (exponents). METHODS AND RESULTS Stroke volume (SV) by M-mode echocardiography was related to height, weight, body surface area (BSA), and ideal BSA (derived from ideal body weight for given height) in 970 normotensive individuals (1 day to 85 years old; 426 < 18 years old; 204 overweight to obese; 426 female). In normal-weight children, adults, and the entire population, SV was related by allometric relations to BSA (power = 0.82 to 1.19), body weight (power = 0.57 to 0.71), and height (power = 1.45 to 2.04) (all P < .0001). Relations of cardiac output to measures of body size had lower allometric powers than those for SV in the entire population (0.41 for body weight, 0.62 for BSA, and 1.16 for height). In overweight adults, observed SVs were 17% greater than predicted for ideal BSA, a difference that was approximated by normalization of SV for height to age-specific allometric powers. Similarly, observed cardiac output was 19% greater than predicted for ideal BSA, a difference that was accurately detected by use of cardiac output/height to age-specific allometric powers but not of BSA to the first power. CONCLUSIONS Indices of SV and cardiac output for BSA are pertinent when the effect of obesity needs to be removed, because these indices obscure the impact of obesity. To detect the effect of obesity on LV pump function, normalization of SV and cardiac output for ideal BSA or for height to its age-specific allometric power should be practiced.

[1]  S. Daniels,et al.  Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. , 1992, Journal of the American College of Cardiology.

[2]  G. Kronik,et al.  Comparative value of eight M-mode echocardiographic formulas for determining left ventricular stroke volume. A correlative study with thermodilution and left ventricular single-plane cineangiography. , 1979, Circulation.

[3]  S. Daniels,et al.  Effect of lean body mass, fat mass, blood pressure, and sexual maturation on left ventricular mass in children and adolescents. Statistical, biological, and clinical significance. , 1995, Circulation.

[4]  B. Rosner,et al.  Blood pressure nomograms for children and adolescents, by height, sex, and age, in the United States. , 1993 .

[5]  D. Bonaduce,et al.  Assessment of cardiac autonomic control by heart period variability in patients with early‐onset familial obesity , 1995, European journal of clinical investigation.

[6]  M. Digirolamo,et al.  Hemodynamic and metabolic correlates in adipose tissue: pathophysiologic considerations , 1990, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[7]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[8]  J. Laragh,et al.  Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. , 1995, Journal of the American College of Cardiology.

[9]  W. Dietz,et al.  Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. , 1994, The American journal of clinical nutrition.

[10]  Jerrold H. Zar,et al.  Calculation and Miscalculation of the Allometric Equation as a Model in Biological Data , 1968 .

[11]  R. Devereux,et al.  Reproducibility of Echocardiographic Left Ventricular Measurements , 1987, Hypertension.

[12]  F. Dunn,et al.  Borderline Hypertension and Obesity: Two Prehypertensive States with Elevated Cardiac Output , 1982, Circulation.

[13]  S Sasayama,et al.  Ventriculoarterial coupling in normal and failing heart in humans. , 1989, Circulation research.

[14]  F. Messerli CARDIOVASCULAR EFFECTS OF OBESITY AND HYPERTENSION , 1982, The Lancet.

[15]  G. de Simone,et al.  Echocardiography in arterial hypertension: when, why and how? , 1994, Journal of hypertension.

[16]  M. Roman,et al.  Measurement of cardiac output by M-mode and two-dimensional echocardiography: application to patients with hypertension. , 1990, European heart journal.

[17]  J. Laragh,et al.  Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. , 1994, Journal of the American College of Cardiology.

[18]  D. Levy,et al.  A new method for indexing left ventricular mass for differences in body size. , 1994, The American journal of cardiology.

[19]  C. Rembold,et al.  Growth of the human heart relative to body surface area. , 1990, The American journal of cardiology.

[20]  G. Forbes Stature and lean body mass. , 1974, The American journal of clinical nutrition.

[21]  R. Lauer,et al.  Factors affecting left ventricular mass in childhood: the Muscatine Study. , 1993, Pediatrics.

[22]  S. Daniels,et al.  Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. , 1995, The American journal of cardiology.

[23]  B. Gutin,et al.  Impact of body fat mass and percent fat on metabolic rate and thermogenesis in men. , 1989, The American journal of physiology.

[24]  R Gorlin,et al.  Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. , 1976, The American journal of cardiology.

[25]  S. Daniels,et al.  Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults. , 1988, Journal of the American College of Cardiology.

[26]  J. Laragh,et al.  Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. , 1994, Hypertension.

[27]  S. Gidding,et al.  Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. , 1995, Circulation.