Reference values of aortic flow velocity integral in 1193 healthy infants, children, and adolescents to quickly estimate cardiac stroke volume

Abstract

The aortic velocity time integral (VTI) is an echocardiographic tool used to estimate cardiac output (CO) by multiplying it with the aortic valve (AV) area and heart rate (HR). Inaccurate measurement of AV diameter will lead to squared miscalculation of CO. The aortic VTI itself can serve as a left-ventricular (LV) output parameter. The normal range of aortic VTI in adulthood is relatively stable, compared with childhood, but reference data are lacking. The aim of this study was to establish reference values of VTI in infants, children, and adolescents. A retrospective analysis of 1223 echocardiographic examinations of healthy children (age 0-20 years, body surface area [BSA] 0.11-2.23 m(2)) was performed. Data were correlated with age, BSA, and HR, and age subgroups with normal distribution were determined. Interobserver and intraobserver variability was calculated. Aortic VTI ranged from mean 13.8 cm (10.0-18.4 cm 5-95th percentile) in neonates to 25.1 cm (19.6-32.8 cm 5-95th percentile) in children >17 years of age and had a positive correlation with age (r = 0.685, p < 0.001), BSA (r = 0.645, p < 0.001) and a negative correlation with HR (r = -0.710, p < 0.001). Interobserver and intraobserver variability were excellent (3.9 ± 3.1 and 4.6 ± 3.7 %, respectively). Calculated mean values and percentile charts for the different age groups can serve as reference data to easily judge LV output in patients with or without congenital heart disease without enlargement or dysfunction of the AV.