{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:50:24Z","timestamp":1791384624787,"version":"4.3.3"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>\n              Cardiovascular dimensions measured during pediatric echocardiograms must be normalized for body size. However, other variables may confound their interpretation, such as age and abnormal body habitus. This retrospective cross-sectional study of the Canadian Congenital and Pediatric Cardiology Research Network aimed to create\n              <jats:italic toggle=\"yes\">Z<\/jats:italic>\n              score equations for commonly measured dimensions in pediatric 2-dimensional echocardiography that were free of residual confounding effects of body size, body mass index, and age.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>The reference sample consisted of &gt;20\u2009000 children without heart disease from 9 institutions who underwent clinical echocardiography that was reported as normal. A generalized additive model for location, scale, and shape (GAMLSS) was used to model the expected distributions of measurements as a function of sex, height, weight, body mass index, and age.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Compared with a model that only considered body surface area, the proposed\n              <jats:italic toggle=\"yes\">Z<\/jats:italic>\n              scores demonstrated less bias in subgroups of overweight, young, and early school-aged children.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>\n              The proposed\n              <jats:italic toggle=\"yes\">Z<\/jats:italic>\n              score equations may improve diagnostic and therapeutic accuracy by ensuring that body size, body mass index, and age do not confound the interpretation of measurements.\n  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