Left ventricular mass normalization in child and adolescent athletes must account for sex differences

Hubert Krysztofiak , Marcel Młyńczak , Łukasz A. Małek , Andrzej Folga , Wojciech Braksator


To assess left ventricular hypertrophy, actual left ventricular mass (LVM) normalized for body size has to be compared to the LVM normative data. However, only some published normative echocardiographic data have been produced separately for girls and boys; numerous normative data for the pediatric population are not sex-specific. Thus, this study aimed to assess whether the LVM normative data should be developed separately for girls and boys practicing sports.

Left ventricular mass was computed for 331 girls and 490 boys, 5–19 years old, based on echocardiography. The effect of sex on the relationship between LVM and body size was evaluated using a linear regression model. Seven sets of the LVM normative data were developed, using different methodologies, to test concordance between sex-specific and non-specific normative data. Every set consisted of normative data that was sex-specific and non-specific. Upon these normative data, for every study participant, seven pairs of LVM z-scores were calculated based on her/his actual LVM. Each pair consisted of z-scores computed based on sex-specific and non-specific normative data from the same set.

The regression lines fitted to the data points corresponding to LVM of boys had a higher slope than of girls, indicating that sex affects the relationship between LVM and body size. The mean differences between the paired LVM z-scores differed significantly from 0. The percentage of discordant indications, depending on the normalization method, ranged from 66.7% to 100% in girls and from 35.4% to 50% in boys. Application of the LVM normative data that were not sex-specific made relative LVM underestimated in girls and overestimated in boys.

The LVM normative data should be developed separately for girls and boys practicing sports. Application of normative data that are not sex-specific results in an underestimation of relative LVM in girls and overestimation in boys.
Author Hubert Krysztofiak - Instytut Medycyny Doświadczalnej i Klinicznej im. Mirosława Mossakowskiego Polskiej Akademii Nauk
Hubert Krysztofiak,,
, Marcel Młyńczak (FM / IMBE)
Marcel Młyńczak,,
- The Institute of Metrology and Biomedical Engineering
, Łukasz A. Małek - Instytut Kardiologii im. Prymasa Tysiąclecia Stefana Kardynała Wyszyńskiego
Łukasz A. Małek,,
, Andrzej Folga - National Centre for Sports Medicine
Andrzej Folga,,
, Wojciech Braksator - Medical University of Warsaw (WUM)
Wojciech Braksator,,
Journal seriesPLoS ONE, ISSN 1932-6203
Issue year2020
Publication size in sheets0.3
Article numbere0236632
Keywords in Englishadolescent, adult, article, athlete, body size, child, echocardiography, femaleheart left ventricle mass, humanlinear regression analysis, major clinical study, malesex difference
ASJC Classification2700 General Medicine; 1100 General Agricultural and Biological Sciences; 1300 General Biochemistry, Genetics and Molecular Biology
URL https://doi.org/10.1371/journal.pone.0236632
Languageen angielski
LicenseJournal (articles only); published final; Uznanie Autorstwa (CC-BY); after publication
WUT729d8e6d0f7f48209a1b9d4f58027b27.pdf 2.12 MB
Score (nominal)100
Score sourcejournalList
ScoreMinisterial score = 100.0, 11-08-2020, ArticleFromJournal
Publication indicators Scopus SNIP (Source Normalised Impact per Paper): 2017 = 1.111; WoS Impact Factor: 2018 = 2.776 (2) - 2018=3.337 (5)
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